Suicide Prevention Training Research Articles

Economic evaluation of nine intersectoral strategies to improve youth mental health and alleviate financial burden in Colombia using system dynamics modelling

ObjectivesLimited evidence exists for strategic actions in improving the youth population-level mental health, particularly in low- and middle-income countries. This study investigates the health and economic impacts of inter-sectoral mental health programs to inform the optimal suite of interventions for young people in Bogotá, Colombia, where many are at risk of mental disorders and lack access to appropriate health services. MethodsThis study examined nine interventions compared to business-as-usual over a projected 10-year time horizon using a system dynamics model developed through a participatory process involving diverse local stakeholders. Sensitivity analyses were performed to account for uncertainties from a healthcare payer perspective. ResultsAnti-bullying, community-based rehabilitation, and online mental health programs were dominant. GP mental health training and gatekeeper suicide prevention training could significantly improve mental health outcomes at an incremental cost-effectiveness ratio (ICER) below the threshold of 4,890 USD/QALY. However, simultaneously implementing all nine strategies could produce a synergistic effect, yielding the greatest benefit relative to business-as-usual with an incremental net monetary benefit of USD 465 million and an ICER of USD 586 per QALY gained. ConclusionsCombined intersectoral mental health strategies were synergistic and resulted in optimum health outcomes relative to business-as-usual. System dynamics approach offers additional attributes to economic evaluation in mental health settings by considering capacity constraints, unintended consequences, and interactions between multiple interventions. It is a valuable approach for decision-makers to effectively and efficiently prioritise and allocate scarce resources in complex public health systems.

Suicide Prevention across the Community: Evaluation of Mental Health Training for Multiple Gatekeeper Groups

Introduction. The USA experiences higher suicide rates than the global average, with rural rates even higher. The present study examined whether a single suicide prevention training could increase knowledge, awareness, and intention to act among multiple gatekeeper populations in Kansas, a rural state with elevated suicide rates. Methods. An evidence-based suicide prevention training program was developed by licensed clinical psychologists at a public university in Kansas and offered online to multiple recruitment groups: university faculty/staff and students, healthcare workers, and other community members on a voluntary basis; high school staff and students on a compulsory basis. Participants reported knowledge, awareness, and intention on a Likert-type scale and indicated whether they had completed previous suicide prevention training. 865 participants provided retrospective pre/post results. Paired samples t-tests were run on the full set and each recruitment group. Repeated measures ANOVAs compared results by recruitment group and previously trained status. Results. Overall, by recruitment group, and by previously trained status, participants demonstrated statistically significant pre/post increases on all items. ANOVA found no significant differences between recruitment groups. Participants with previous training reported less change in scores but still increased scores significantly. Conclusions. Findings support the efficacy of using a single suicide prevention training across multiple populations. This has implications for allotting limited resources in an environment of high need.

Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds

BackgroundSuicide-related behaviours and individual risk factors for suicide differ between ethnicities and demonstrate additional variation based on voluntary and forced migration. People forcibly displaced by violence and conflict, such as those seeking asylum and refugees, are likely to face stressors that can increase suicide risk. Research into evidenced-based suicide prevention strategies among people from asylum-seeking and refugee backgrounds is scarce. However, early, contextually-appropriate, identification and intervention may be a promising way to facilitate support for people in these groups. This research proposes that a contextually-responsive gatekeeper training is an appropriate strategy to increase the identification and support for people from asylum-seeking and refugee backgrounds.MethodsThe present article relates to the statistical findings of a larger mixed-method study used to validate and refine a contextually-responsive gatekeeper training program. The qualitative results of this research will be published separately. The outcome measures – knowledge about suicide in multicultural contexts, attitudes towards suicide and prevention, and self-efficacy to intervene were measured quantitatively, adopting a similar pre- and post-training procedure used in previous training evaluations. Using Generalised Estimating Equations, statistical comparisons were made between three identical self-report surveys completed by participants across three consecutive time points – pre-training, immediately post-training, and three months following training completion – known in this investigation as time-point zero (T0), time-point one (T1), and time-point two (T2). Lastly, during the T2 follow-up, additional open-ended questions were included to understand which areas of training they feel prepared them effectively and how the program could have better prepared them to intervene.ResultsA total of 28 participants took part in the study. Quantitative analysis indicated the program’s capacity to exert a significant favourable and lasting influence on knowledge about suicide and self-efficacy to intervene. In addition, follow-up measurements suggest that the content delivered to participants transferred effectively into real-world suicide prevention behaviours.ConclusionsFindings suggest that tailored suicide prevention training can have a significant influence on knowledge about suicide in multicultural contexts, self-efficacy to intervene in a crisis, and that course content translates effectively into real-world suicide prevention behaviour. Modifying training practices, based on feedback from contextually-experienced attendees, appears to be a pivotal factor in promoting the support of people from asylum-seeking and refugee backgrounds.

Implementing LEARN: Comprehensive Suicide Prevention Training for High School Students, Parents, and School Personnel.

Adolescent suicide is a public health issue, and school is an ideal setting for prevention activities. LEARN is a peer-led gatekeeper training for high school personnel, parents, and students. The purpose of this study was to evaluate the effectiveness of LEARN as a gatekeeper training. Paired t tests were used to compare pre- and post-training surveys for 4983 LEARN participants. Participants reported an increased likelihood of engaging in each LEARN step: looking for signs, empathizing and listening, asking about suicide thoughts and plans, reducing danger, and connecting the person with help. Most participants were highly satisfied with the peer trainer's delivery of content. LEARN gatekeeper training was successfully implemented in high schools with students, parents, and school personnel. All groups reported increases in likelihood of approaching and providing support and connections for at-risk individuals and rated the trainer as effective, indicating satisfaction with the peer-led training format.

Systems modelling and simulation to guide targeted investments to reduce youth suicide and mental health problems in a low–middle-income country

BackgroundDespite suicide’s public health significance and global mental health awareness, current suicide prevention efforts show limited impact, posing a challenge for low- and middle-income countries. This study aimed to develop a dynamic simulation model that could be used to examine the potential effectiveness of alternative interventions for reducing youth mental health problems and suicidal behavior in Bogotá, Colombia.MethodsA system dynamics model was designed using a participatory approach involving three workshops conducted in 2021 and 2022. These workshops engaged 78 stakeholders from various health and social sectors to map key mental health outcomes and influential factors affecting them. A model was subsequently developed, tested, and presented to the participants for interactive feedback, guided by a moderator. Simulation analyses were conducted to compare projected mental health outcomes for a range of intervention scenarios with projections for a reference scenario corresponding to business-as-usual.ResultsA total of 6670 suicide attempts and 347 suicides are projected among 7 − 17-year-olds from January 1, 2023, to early 2031 under the business-as-usual scenario. Mental health issues among 12 − 17-year-olds are projected to increase from 18.9% (2023) to 27.8% (2031), and substance use issues from 2.29 to 2.49% over the same period. School-based suicide prevention and gatekeeper training are the most effective strategies, reducing total numbers of suicide attempts and suicides by more than 20% (i.e., compared to business-as-usual). However, discontinuous funding significantly hinders these effective suicide prevention efforts.ConclusionsSystems modelling is an important tool for understanding where the best strategic financial and political investments lie for improving youth mental health in resource-constrained settings.

Preparing for Patient Care: A Pre-clerkship Curricular Thread to Improve Learners’ Knowledge, Attitudes, and Confidence Treating Patients at Risk for Suicide

AbstractSuicide is a leading cause of death. Unfortunately, stigma still surrounds depression and mental health treatment. Many health care providers are uncomfortable broaching the topic with patients. There is an urgent need to better equip future physicians to compassionately identify and treat patients at risk for suicide. To address this problem, we created a novel suicide prevention spiral curricular thread for advanced pre-clerkship medical students. Mixed methods surveys were administered before and after the curriculum. Following completion of the curriculum, learners’ confidence identifying and treating patients at risk of suicide significantly increased. Attitudes including professional confidence, therapeutic optimism, and generalist perspective measured by the Revised Depression Attitudes Questionnaire also increased, indicating reduced stigmatizing attitudes and increased knowledge and confidence. Participants reported that engaging in the standardized patient encounter was the most impactful event, although the prior events provided necessary foundational training. This study demonstrates the feasibility and effectiveness of a curricular thread approach during the pre-clerkship phase for training medical students in suicide prevention to prepare them for patient care. Other medical schools can use this framework to design and integrate suicide prevention training into their own curricula.

Comparing three methods to assess learning outcomes for a suicide prevention training program for pharmacy staff

ObjectiveTo examine whether pharmacists and pharmacy staff who complete a suicide prevention gatekeeper training program (Pharm-SAVES) react similarly to a written patient case, a live simulated patient (SP), and a prerecorded SP case. MethodsAfter completing the 30-min Pharm-SAVES training, participants completed a written patient case via survey and then, 1 month later, completed a prerecorded SP and live SP interaction via Zoom. For each assessment type, we documented whether the participant asked about suicide and referred the patient to the Suicide and Crisis Lifeline (988). ResultsParticipants (n = 12) asked about suicide in 8 (67 %) written patient cases, 9 (75 %) prerecorded SP cases, and 8 (67 %) live SP cases. Participants referred patients to 988 in 8 (67 %) written patient cases, 5 (42 %) prerecorded SP cases, and 10 (83 %) live SP cases. ConclusionThe number of participants who asked about suicide was similar regardless of assessment type; however, referrals to the Suicide & Crisis Lifeline happened less often with the prerecorded SP cases. InnovationThis is the first study to compare key learning outcomes of pharmacy suicide prevention gatekeeper training across written, live, and prerecorded SP encounters.

What is known about suicide prevention gatekeeper training and directions for future research.

Suicide prevention training that teaches skills to support a person experiencing thoughts of suicide and create community support networks, often termed, "gatekeeper" training (GKT), has been a longstanding pillar of international, national, and local suicide prevention efforts. GKT aims to improve knowledge, attitudes, and self-efficacy in identifying individuals at risk for suicide, hopefully enhancing one's willingness and ability to intervene with a person experiencing a crisis. However, little is known about GKT's effectiveness in creating the essential behavior change (e.g., increase in intervening behaviors) it sets out to accomplish. This paper explores the history and theoretical background of GKT, reviews the current state of research on GKT, and provides framing and recommendations for next steps to advance research and practice around GKT. Through positioning GKT appropriately within the field of suicide prevention, we argue that the field of suicide prevention needs more rigorous research around GKT that includes long-term follow-up data on usage of skills learned during training, data on outcomes of those who have received an intervention from a trained gatekeeper, and the integration of implementation science to further our understanding of which trainings are appropriate for which helpers.

Impact of a suicide prevention learning module for firearm training courses in Louisiana

BackgroundFirearm suicide is a leading cause of death in the United States. Suicide prevention experts have advocated for upstream interventions that can be implemented prior to the development of suicidal thoughts, particularly those that focus on lethal means safety (LMS; e.g., increasing secure firearm storage). To reach firearm owners with LMS messaging, researchers have developed suicide prevention training content which can be incorporated into firearm training courses. However, no study to date has evaluated impact of such training on firearm course students’ subsequent knowledge, attitudes, and openness related to secure firearm storage. Thus, the current study sought to examine both the feasibility and acceptability of a LMS-focused suicide prevention training module among firearm course students, as well as the impact of this module on students’ secure firearm storage-related knowledge, attitudes, and openness.MethodsFirearm instructors (N = 6) and students in firearm classes (N = 83) were recruited to participate. Students were invited to complete voluntary, anonymous pre- and post-surveys during courses they attended that were led by these instructors. Instructors and students were also invited to complete a brief qualitative interview.ResultsResults indicated that firearm instructors and students in firearm courses found the module feasible and acceptable. Additionally, students’ knowledge about the relationship between firearms and suicide, openness to changing firearm storage practices, and endorsement of the importance of discussing firearms and suicide with fellow firearm owners, as well as willingness and confidence to do so, all significantly increased after viewing the module.ConclusionsThese findings provide strong support for the use of such culturally competent LMS messaging as upstream suicide prevention in settings such as concealed carry courses.

Effects of an Avatar-Based Simulation on Family Nurse Practitioner Students' Self-Evaluated Suicide Prevention Knowledge and Confidence.

Family nurse practitioners (FNPs) are often gatekeepers and can recognize the warning signs of suicidality yet may lack adequate education or self-confidence in identifying people in crisis. The purpose of this research was to evaluate the effectiveness of an online suicide prevention simulation with 53 FNP students. Pre/post responses were found to be statistically significant across all preparedness and attitudinal items following the Kognito© training (p < .001). Online, avatar-based suicide prevention training with FNP students may be effective in improving participants' perceived preparedness and self-confidence with patients at risk for suicidality.

Key Improvements to the Army's Suicide Prevention and Intervention Training: An Interagency Collaboration to Develop the New "ACE Base +1" Curriculum.

Suicide is a prevalent problem impacting the military community. The U.S. Army recognized the need to address this complex issue; one line of effort has been to provide suicide prevention and intervention education and training that is informed by current research, doctrine, and implementation best practices. The purpose of this article is to outline and present the genesis of the Army's new suicide prevention and intervention training-"Ask, Care, Escort (ACE) Base +1"-that aligns with the DoD newly published regulation-driven initiatives. The development of the "ACE Base +1" curriculum was a collaborative effort between two organizations within the Defense Health Agency: The Defense Centers for Public Health-Aberdeen and the WRAIR. A multidisciplinary team was formed by selecting specific operational and subject-matter experts from each organization based on educational qualifications and practical experiences expected to aid the development of curriculum content (e.g., subject-matter experts) and/or the training design. Revisions to the curriculum were informed by the Army's existing suicide prevention training module, current research in suicide prevention and public health, updated and relevant Army regulations, and current public health policy guidance from the CDC and the Department of Suicide Prevention Office. A detailed account of the systematic and iterative curriculum development process is provided. The interagency collaborative efforts resulted in a suite of training products, "ACE Base +1" version 1.3 that is modernized in training content, delivery methods, and design. Four primary elements shaped the final products: (1) A modular framework allowing a tailored approach to mandatory training, (2) a public-health approach that focuses on earlier intervention opportunities while building trust and cohesion, (3) a training design centered on peer discussions and behavioral rehearsal, and (4) an expansion of the curriculum to be inclusive of the entire Army community. Practical implications for each element are discussed.As the program of record, "ACE Base +1" training satisfies the annual requirement for all Active Army, Army National Guard, U.S. Army Reserve, and Department of the Army (DA) civilians. Both the training content (e.g., public-health concepts) and design of "ACE Base +1" reflect a comprehensive approach, focused on developing concrete, applicable skills that support the shared responsibility to suicide prevention and intervention. Limitations, such as delayed interagency collaboration and time constraints, are discussed. Future directions include recommendations for future curriculum projects, specifically within military populations, such as interprofessional, interagency collaboration, and selecting a multidisciplinary team of subject-matter experts. Additionally, WRAIR plans to continue their support to Directorate of Prevention, Resilience and Readiness with the expansion of the +1 menu of trainings, ongoing program evaluation, and longitudinal analysis to inform future revisions and ensure the content and delivery methods remain modernized, relevant, and effective.

Development of a Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea (Suicide CARE Version 2.0) to Prevent Adolescent Suicide: Version for Teachers.

The increasing concern over adolescent suicide necessitates suicide prevention training for school teachers, as students spend a significant portion of their time at school. This study's objective is to develop a suicide prevention program tailored for teachers. The program was developed by a multidisciplinary research team, drawing on a review of both domestic and international suicide prevention programs, related scholarly articles, and Korean psychological autopsy interviews of adolescents. This was complemented by a survey of teachers to assess the program's practicality and usability. The developed program comprises three parts, consistent with other versions: Careful Observation, Active Listening, and Risk Evaluation and Expert Referral. Careful Observation focuses on training teachers to recognize verbal, behavioral, and situational warning signs of suicidal ideation in students; Active Listening involves strategies for encouraging students to express their suicidal thoughts and techniques for being an empathetic and attentive listener; Risk Evaluation and Expert Referral provides instruction on how to assess suicide risk and assist students safely. It is anticipated that this program will equip teachers with valuable knowledge and skills, contributing to a reduction in adolescents suicide rates.

Suicide Prevention Training for Social Work Students in Rural Practicum Placements: Current Opportunities and Areas for Growth

ABSTRACT Students and practicum instructors in a primarily rural state were surveyed about suicide prevention practice and training opportunities provided to social work trainees during their practicum placements. A cross-sectional, electronic survey was administered to N = 86 students and N = 64 practicum instructors and descriptive statistics were analyzed. Most students (87.1%) and practicum instructors (86.6%) felt that students should have the opportunity to engage with suicidal clients while in practicum. Many students reported having had contact with a suicidal client while in practicum (70.6%) and had engaged in some sort of practice related to suicide prevention (82.6%). The most frequently reported practice behaviors were suicidal inquiry (62.8%), risk assessment (60.7%), disposition planning (51.0%), and safety planning (49.0%). Over half (52.9%) had not used any evidence-based tools for screening and follow-up and only one quarter (25.5%) had provided postvention services. Many students (72.9%) were concerned about iatrogenic risk. Although most practicum instructors felt comfortable addressing suicide prevention in supervision (74.4%), many (64.1%) also reported the desire for additional training. Although students appear to have opportunities to engage in suicide prevention in practicum, there are specific knowledge and practice gaps regarding evidence-based tools, postvention, and the “myth” of iatrogenic risk.

A mixed-methods cross-sectional study to evaluate the public acceptability of a novel pharmacy-based response service for domestic abuse and/or suicidal ideation

BackgroundDomestic abuse (DA) and suicidal ideation (SI) are prevalent and often co-occur. Numerous practical and psychosocial barriers inhibit help-seeking, including accessibility and confidentiality concerns. Early intervention and referral are essential for both DA and SI. Pharmacies are accessible and may be perceived as a discreet venue for a DA and SI response service. There is a growing body of literature about the role of community pharmacy teams in suicide prevention and assisting domestic abuse victims globally. Whilst there have been some interventions in UK pharmacies to support domestic abuse victims and encouragement of staff training in suicide prevention, there is currently no commissioned service for DA and/or SI in pharmacies in the UK. ObjectiveTo assess public acceptability of a novel response service in community pharmacy for people in danger from domestic abuse and/or suicidal ideation. MethodsData collection consisted of an online public survey running for 6 weeks and qualitative interviews with pharmacy customers. Descriptive statistics were used to present the survey results and interviews were audio recorded, transcribed verbatim and then analysed using the Framework Analysis method and NVivo 11. ResultsThe majority of 501 survey respondents and all 12 customer interview participants were supportive of offering a response service for DA and/or SI in community pharmacy. Participants emphasised the need for appropriate staff training and support. They considered it an ethical and accessible approach and the majority said that they would recommend such a service to family or friends, and use it themselves if needed. However, awareness of the service was low and marketing materials were considered insufficiently clear. ConclusionsThere is strong public support and acceptability for a response service covering both suicidal ideation and domestic abuse in community pharmacies. Further research is required to develop appropriate marketing materials.

A Phenomenological Investigation of Counselors’ Perceived Preparedness With Suicidal Clients

The purpose of this phenomenological study was to understand the essence of counselors’ perceived preparedness working with suicidal clients and to provide suicide prevention and assessment recommendations for the counseling profession. We identified a structural-textural description that highlights the perceived amount, quality, and components of training preparedness, as well as suicide assessment and intervention knowledge. This phenomenological investigation included 10 professional counselors who described the degree to which they felt prepared to work with suicidal clients and their perceptions of the suicide prevention and assessment training they have completed during their training program and in their agency work setting. Counselors did not generally feel that their training had been adequate and subsequently sought more through personal learning or on-the-job training. Counselors should seek out evidence-based trainings that best meet the needs of their clients.

Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review.

This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts. An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool. Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%). HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

One-Hour Suicide Prevention Training Makes a Difference!

Nurses and other healthcare workers in the United States are at increased risk of suicide compared to non-healthcare workers. College students also experience high suicide risk. To impact suicide prevention in these populations, a Question, Persuade, Refer (QPR) 1-hour gatekeeper suicide prevention training program was implemented at the University of Detroit Mercy for faculty, staff, and administrators in the College of Health Professions (N = 43). Knowledge in seven areas of suicide significantly increased after the training (p < .001). Sixteen attitudes about suicide improved; however, only two showed a statistically significant change. Results support that 1-hour QPR training can be effectively implemented in a large organization.

One-Hour Suicide Prevention Training Makes a Difference!

One-Hour Suicide Prevention Training Makes a Difference!

Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT) for US Veterans With Serious Mental Illness: Community Engagement Approach.

Peer specialists are hired, trained, and accredited to share their lived experience of psychiatric illness to support other similar individuals through the recovery process. There are limited data on the role of peer specialists in suicide prevention, including their role in intervention development. To better understand peer specialists within the Veterans Health Administration (VHA), we followed partnership community engagement and a formative research approach to intervention development to (1) identify barriers, facilitators, and perceptions of VHA peer specialists delivering a suicide prevention service and (2) develop and refine an intervention curriculum based on an evidence-informed preliminary intervention framework for veterans with serious mental illness (SMI). Following the community engagement approach, VHA local and national peer support and mental health leaders, veterans with SMI, and veteran peer specialists met to develop a preliminary intervention framework. Next, VHA peer specialist advisors (n=5) and scientific advisors (n=6) participated in respective advisory boards and met every 2-4 months for more than 18 months via videoconferencing to address study objectives. The process used was a reflexive thematic analysis after each advisory board meeting. The themes discussed included (1) the desire for suicide prevention training for peer specialists, (2) determining the role of VHA peer specialists in suicide prevention, (3) integration of recovery themes in suicide prevention, and (4) difficulties using safety plans during a crisis. There were no discrepancies in thematic content between advisory boards. Advisor input led to the development of Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT). SUPPORT includes training in general suicide prevention and a peer specialist-delivered intervention for veterans with SMI at an increased suicide risk. This training aims to increase the competence and confidence of peer specialists in suicide prevention and the intervention supports veterans with SMI at an increased suicide risk through their recovery process. This paper intends to document the procedures taken in suicide prevention intervention development, specifically those led by peer specialists, and to be a source for future research developing and evaluating similar interventions. ClinicalTrials.gov NCT05537376; https://classic.clinicaltrials.gov/ct2/show/NCT05537376.

Changes in State Laws on Suicide Prevention Training for School Staff, 2002-2022.

Youth suicide is an urgent public health problem. Gatekeeper training aims to prevent suicide by training people to identify warning signs and make referrals to appropriate services. Many states in the United States have enacted gatekeeper training laws (GTLs) to train school staff in suicide prevention. The objectives of this study were to describe the development of a dataset on GTLs and use the dataset to summarize trends in uptake of GTLs from 2002 through 2022 as well as differences in characteristics (eg, frequency and duration of training) of GTLs. We used publicly available legal databases from all 50 states and the District of Columbia to conduct a policy surveillance assessment of GTLs. We cross-checked data with the American Foundation for Suicide Prevention's 2022 Suicide Prevention in Schools (K-12) issue brief and used Westlaw Edge to conduct a sensitivity analysis. We included the following data in the full dataset: type of laws (encouraged, mandatory, or conditional mandatory), date passed, effective date, frequency of training, and length of training. In 2022, 49 states and the District of Columbia had GTLs, 31 of which were mandatory laws. In 2002, only 6 states had such laws, and none were mandatory. The growing proliferation of laws on suicide prevention training for school staff warrants evaluation of the laws' effectiveness. Our policy surveillance data may be used to better understand the role of these laws in a school-based approach to youth suicide prevention.