There are more than 3,000 suicide deaths in California each year—roughly nine deaths for every 100,000 California residents. To prevent suicides and other mental health problems, the California Mental Health Services Authority (CalMHSA) is implementing a variety of Prevention and Early Intervention (PEI) initiatives. CalMHSA is an organization of county governments working to improve mental health outcomes for individuals, families, and communities. PEI programs implemented by CalMHSA are funded through the voter-­approved Mental Health Services Act (Prop. 63). Prop. 63 provides the funding and framework to expand mental health services to previously underserved populations and all of California’s diverse...

More than 36,000 Americans die by suicide every year and another 465,000 receive medical care for self-inflicted injuries. In 2009, suicide was the 10th leading cause of death among people age 10 and older in the United States, accounting for 36,891 deaths (Centers for Disease Control and Prevention, 2012). For every person who dies by suicide, more than 30 others attempt suicide. Suicide places a heavy burden on the nation in terms of the emotional suffering that families and communities experience as well as the economic costs associated with medical care and lost productivity. Since the 1999 release of the...

Although the literature provides a number of different definitions of suicide, it is generally referred to as a self-inflicted behavior that results in a fatal injury, and for which there is evidence of some intent to die as a result of the behavior. Between 1999 and 2009 there have been between 2,831 (in 2001) and 3,823 (in 2009) suicide deaths each year in California. This corresponds to an average suicide rate of 9.4 per 100,000 individuals (range: 8.2 in 2001 to 10.3 per 100,000 in 2009). As shown in Figure 1, over this period, the suicide rate in California has...

The types of suicide prevention programs identified in our literature review differed widely, and the majority of the evaluation studies we reviewed were either quasi-experimental or non-experimental. In addition, changes in rates of suicides can be difficult to detect without a very large sample size, and many studies did not assess whether the program reduced deaths by suicide. Instead, these studies often used more proximal “program goals” to indicate whether the program was effective. Therefore, the evidence that specific programmatic approaches were effective in reducing suicides was also highly variable. Because of this variation, we have organized the literature review...

After reviewing the literature, we thought it necessary to identify measures used to evaluate programs in light of the aforementioned challenges inherent in showing that a program reduces suicides or suicide attempts. We identified sample measures that correspond to each of the proximal program goals identified in our conceptual model, as well as measures of the ultimate outcome—suicidal behaviors (see Table 2). Measures related to knowledge, skills, and attitudes were the primary measures used in past evaluations of media campaigns and individual and gatekeeper training programs. Evaluations of programs focused on increasing identification of individuals’ knowledge or level of...