Policy Priority: Disproportionately Affected Communities and Populations

AFSP advocates for access to culturally appropriate and evidence-based mental health care and suicide prevention services supporting populations at increased risk for suicidal behavior. AFSP fights for equitable, inclusive policies and seeks to learn from diverse populations in underserved communities how to best promote mental health and prevent suicide.

Certain populations uniquely at risk continue to be underrepresented in suicide research and face disproportionate inequities in accessing the care, support, and services needed to improve mental health and prevent suicide. These include, but are not limited to, the following individuals and communities of color: African Americans and Black Americans; American Indians, Alaskan Natives, Hawaiian Natives, and other Indigenous peoples; Asian Americans and Pacific Islanders; and Chicano, Latine, and Hispanic communities. Other vulnerable populations include immigrants, refugees, and those seeking asylum; LGBTQ individuals and communities; individuals living with disabilities and other chronic health conditions; and those experiencing maternal/perinatal mental health conditions. In addition, individuals employed in certain roles along with their families and caregivers, such as first responders, corrections staff, healthcare workers, construction workers, individuals in the farming and agriculture sectors, active-duty service members, and Veterans are often underrepresented in suicide research and face inequities in accessing care and services needed to improve mental health and prevent suicide. Suicide and suicidal behavior also continue to be a major public health crisis among middle-aged white males and among youth and young adults.

Research has highlighted the link between suicide among first responders and Post Traumatic Stress Disorder or Post Traumatic Stress Injury (PTSD/PTSI). First responders, corrections staff, and healthcare workers often experience occupational hazards and stressors on the job, such as traumatic events and shift work, which can in turn increase risk for suicidal behavior or exacerbate existing risk for suicide related to other factors. Individuals employed in these fields may also experience a culture that discourages showing perceived signs of weakness or vulnerability, which can contribute to a reluctance to seek help or self-disclose behavioral health concerns or suicidal thoughts. AFSP supports policies that seek to create a workplace culture where it is a sign of strength to seek help and that supports first responders, corrections staff, and healthcare workers in all aspects of their health, including behavioral health.

• Identify PTSD/PTSI suffered by a first responder, healthcare worker, and corrections staff as a compensable, work-related injury.
• Extend eligibility for life insurance benefits to families of first responders who die by suicide.
• Establish employee assistance programs (EAPs), peer-support programs, additional federal funding sources, and training programs for job-related stress management, burnout prevention, and suicide prevention.
• Provide privacy protections for healthcare workers seeking care from within their own health systems.

Lesbian, gay, bisexual, transgender, and queer persons and those who are questioning their sexual orientation or gender identity (LGBTQ) experience significant health and behavioral health disparities, including elevated rates of suicide attempts. Data on sexual orientation, gender identity, and gender expression are not routinely collected at the time of death, which means researchers do not have reliable data about LGBTQ suicide deaths. However, research has shown that the social stigma, prejudice, and discrimination associated with minority sexual orientation and gender identity contribute to elevated rates of suicidal thoughts, plans, and attempts and poorer mental health found in LGBTQ people. This includes institutional discrimination resulting from laws and public policies that create inequities or fail to provide protections against sexual orientation-based discrimination. Experiences of stigma and discrimination increase risk of depression and other risk factors for suicidality, while protective actions like increasing acceptance and affirmation of LGBTQ identities and increasing access to LGBTQ-affirming physical and mental healthcare reduce the likelihood of LGBTQ suicide attempts and deaths and promote wellbeing.

• Integrate LGBTQ populations into existing data collection tools on suicide mortality and risk behavior.
• Support bans on conversion therapy/sexual orientation change efforts.
• Oppose restrictions on access to gender-affirming medical care.
• Oppose restrictions on discussion in schools on LGBTQ issues.

Suicide risk among service members and Veterans is greater than that of the general population. The Department of Veterans Affairs’ (VA’s) 2023 National Suicide Prevention Annual Report states the unadjusted suicide rate among Veterans in 2021 was more than double that of non-Veteran adults (102% higher).. A 2021 study found that, since 9/11, suicides among active-duty personnel and Veterans were four times higher than deaths during military operations. Military families also face unique risks regarding suicide and behavioral health, such as anxiety, isolation, and depression. To address this, AFSP works to improve access to services and recovery through both the VA and community care and to support service members, Veterans, and their families at all stages during and after their service to the United States.

• Increase awareness of and access to timely behavioral healthcare, suicide prevention and crisis response services, and on-base and community supports for service members, Veterans, and their families, including assisting Veterans in accessing earned benefits and services.
• Lower costs for mental health, substance use, and crisis services for service members, Veterans, and their families.
• Fund research and improve data collection on service member and Veteran suicide deaths and attempts.
• Increase suicide risk screening for service members upon discharge/transition to civilian life.

Comprehensive care that addresses all aspects of health, including behavioral health, must be delivered to incarcerated populations, recently incarcerated individuals, and individuals who come into contact with the criminal legal system with the goal of reducing recidivism, supporting public safety, and preventing suicide.

• Establish and expand pre- and post- booking diversion programs, including behavioral health, drug treatment and Veterans courts, and other initiatives to improve responses to individuals with mental health and/or substance use disorders who come into contact with the criminal legal system.
• Promote re-entry policies that assist formerly incarcerated individuals with successful transition to community, in the areas of health and behavioral health care, housing and social supports.
• Improve data collection and reporting on suicide in correctional facilities.
• Support policies that limit the use of solitary confinement and maximize the behavioral health of incarcerated individuals, with the goal of ending its use.
• Expand access to behavioral health care and suicide prevention programming in correctional facilities including suicide prevention training for corrections officers and screening for and identifying individuals at risk for suicide at key points, such as at entry and exit.

Psychological distress, including symptoms of anxiety, depression, ADHD, and other mental health conditions, increases suicide risk among children, teens, and young adults. Mental health challenges are the leading cause of disability and poor life outcomes in young people. Adverse childhood experiences (ACEs), including exposure to child abuse and neglect, are also significant risk factors for suicide. AFSP recognizes these challenges and continues to prioritize policies that increase the ability of K-12 schools, colleges and universities, child welfare agencies, juvenile justice programs and facilities – and the adults that interact with youth regularly in those systems – to recognize and support youth at risk for suicide.

• Maintain and expand funding and grant programs for suicide prevention in K-12 schools and higher education.
• Implement and support comprehensive K-12 school mental health and suicide prevention, intervention, and postvention initiatives and policies, including requirements for personnel training, student education, caregiver education, excused student mental health absences, and regular student, parent, and staff notification of resource availability.
• Require higher education policies and procedures to include how to support students experiencing a behavioral health condition or suicidal crisis and require schools to make those policies and related resources widely known and available to all students, faculty, and staff.
• Improve suicide prevention and behavioral health programs, practices, and policies within the child welfare and juvenile justice systems, including support for youth who are unsheltered.
• Support funding for upstream suicide prevention approaches to address Adverse Childhood Experiences, including programs for families that have interacted with the juvenile justice and criminal legal systems, have experienced suicide loss, or dealt with substance use.

Suicide is a leading cause of preventable maternal mortality. Nationally, it is estimated that up to 20% of maternal deaths are suicides, making maternal suicide deaths more common than deaths from postpartum hemorrhage or hypertensive disorders. Research shows that 62% of pregnancy-related suicides occur between 43-365 days postpartum, 24% occur during pregnancy, and 14% occur within 42 days postpartum; birthing parents who screened positive for depression during the early postpartum period were more likely to have thoughts about suicide during the later postpartum period. The negative impact of maternal mental health and substance use disorders on child development is also well-documented, as is the impact of maternal suicide on child wellness. Parents who can obtain timely care for their behavioral health concerns are able to better care for themselves and their babies.

• Expand Medicaid and CHIP coverage for qualifying pregnant and birthing people and their children up to 12 months postpartum.
• Enhance access to suicide prevention and behavioral health resources for pregnant and birthing people and their families and insurance coverage for maternal/perinatal behavioral health care, to include (but not limited to) coverage for postpartum depression/maternal behavioral health screenings.
• Extend suicide prevention, assessment, treatment, and management training requirements for health providers to include perinatal health providers and nonclinical support personnel (e.g., peer support specialists, community health workers, and doulas).
• Incorporate best practices in crisis support for perinatal populations into training and certification requirements for 988 crisis contact centers and response services.
• Support efforts to nationally standardize and improve data collection initiatives through Maternal Mortality Review Committees and Perinatal Quality Collaboratives.