To date, there have been no effective, broadly applied, comprehensive and sustainable approaches to preventing suicide and risk-related premature deaths in the United States. Rare examples of exceptional programs exist – in the US Air Force and the police force of Montreal, Quebec, Canada – but no one has replicated these results, nor is it clear that they are suitable for dealing with the extraordinary diversity within and between states, let alone an entire country. Preventing suicides and premature deaths – to the extent that there is a substantial reduction in population-level rates – will require systemic, systematically applied and coordinated interventions. They will require carefully crafted public health initiatives that reach far ‘upstream’ while also dealing with persons on the ‘edge of death.’ While suicide is often viewed from the perspectives of individuals who have killed themselves, these deaths are drawn from diverse groups who share common characteristics. Effective prevention programs must address the diversity of these groups even as it is essential to meet the needs of individuals suffering great distress. Suicide prevention must be built as a mosaic; no single piece will convey the entire picture.

This presentation will consider an approach developed with a partner State to design and implement a “full court press” approach necessary for creating and sustaining the mosaic of efforts required for preventing suicide, attempted suicide, and antecedent risks that are common to these adverse outcomes, as well as other related forms of premature death. It will consider the challenges involved when promoting effective, broad based coalitions; the opportunities from forging synergies among diverse groups; the development of dynamic models to explore the impact of programmatic changes and interventions; and the central role of “culture change” that will be essential to creating and sustaining a powerfully effective suicide prevention movement.