Background Efforts in the USA during the 21st century to stem the ever-rising tide of suicide and risk-related premature deaths, such as those caused by drug intoxications, have failed. Based primarily on identifying individuals with heightened risk nearing the precipice of death, these initiatives face fundamental obstacles that cannot be overcome readily.
Objective This paper describes the step-by-step development of a comprehensive public health approach that seeks to integrate at the community level an array of programmatic efforts, which address upstream (distal) risk factors to alter life trajectories while also involving health systems and clinical providers who care for vulnerable, distressed individuals, many of whom have attempted suicide.
Conclusion Preventing suicide and related self-injury morbidity and mortality, and their antecedents, will require a systemic approach that builds on a societal commitment to save lives and collective actions that bring together diverse communities, service organisations, healthcare providers and governmental agencies and political leaders. This will require frank, data-based appraisals of burden that drive planning, programme development and implementation, rigorous evaluation and a willingness to try-fail-and-try-again until the tide has been turned.
- public health
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Contributors All authors contributed to the planning of this paper and the developments described for the Colorado National Collaborative (CNC). The logic model was developed by KQ based on the discussions of the authors and colleagues. EDC drafted the paper and the remaining figures, which were reviewed and approved by all authors.
Funding This work was supported in part by a grant from the US Centers for Disease Control and Prevention (CDC; R49 CE002093).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of CDC.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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