Plan to Reduce
A Data-Driven, Empirical Approach
For the Sustained Reduction of
Suicide in the Sunflower State
The State Suicide Prevention Committee
Accepted by Committee, April 2006
Introduction: Nature of the Problem
Suicide is a tragedy that claims the lives of hundreds of Kansas each year – mothers and
daughters, fathers and sons, brothers and sisters, friends, neighbors. Who completes
suicide? People you meet a work, the grocery store, the gym, and places of worship; children
in our schools, young adults in colleges and universities and older people, some of whom are
facing serious health problems. Maybe someone you know. Maybe someone you love.
In 1998, Kansas had a higher age-adjusted rate of suicide (12.5) than the national average
(11.3). The number of suicides in Kansas is more than 50% higher than the number of
homicides each year. (Center for Health and Environmental Statistics. KDHE. Topeka, Kansas ) (CDC.(1999). Kansas Healthy
People, 2000. US Dept.. of Health and Human Services, Wash. DC)
In 1999, the U.S. Surgeon General issued at Call to Action, identifying suicide as a
preventable public health problem that deserved nationwide focus. His initiative has included
a blue print to increase awareness, improve interventions, and improve research. (U.S. Public
Health Service (1999). The Surgeon General’s Call to Action to Prevent Suicide. Washington, D.C.)
Kansas Observations: Completed Suicides (1995-1998) (Center for Health and Environmental Statistics. KDHE.
• Kansans completed 1,296 suicides between 1995-1998.
• In 60% of completed suicides, firearms were the method of choice.
• The highest rate of firearm related suicides occurred among those ages 75 to 84.
• Males were 5 times more likely than females to complete a suicide with a firearm.
• The highest increases of suicide death rates over time (1989-1998) were seen in the
15-24 age group and the 35-44 age group.
• In the 1996-1998 time interval, suicide was the second leading cause of death for the
age range 25-34. (Dept. of Health and Human Services, CDC (n.d.). State injury profiles for Kansas. Retrieved January
23, 2002 from http://www.cdc.gove/ncipc/State Profiles/indes.htm).
Hospitalizations Related to Self-Inflicted Injuries (Kansas Hospital Association. (2000). Kansas Hospital Discharge
Data System, 1997. (Approximately 53% of all hospital discharges due to injury included an external cause of injury code (E-Code).
Therefore, the findings in this report likely underestimate the overall burden of injury in the State of Kansas.)
• Hospitalizations among females are more common in the 15-19 age group compared
to other age ranges according to #-coding from hospital discharge data.
• 90% of hospitalizations for self-inflicted injuries identified by E-coding were due to
National Observations U.S. Public Health Service (1999). The Surgeon General’s Call to Actin to Prevent Suicide. Washington,
• Suicide is the ninth leading cause of death in the United States, responsible for nearly
31,000 deaths each year.
• The number of suicides occurring in the United States is more than double the number
• Each year, approximately 500,00- persons require emergency room treatment as a
result of an attempted suicide.
• 51% of all firearm deaths in the United States are suicides.
• One in nine 10th graders has made a suicide attempt in the past year.
These disturbing facts of suicide in Kansas and the nation show that it remains a serious
public health problem.
These numbers are troubling, but they do not include the many others who attempt suicide,
but never to go to the hospital. They do not include unreported suicides. Suicide deaths are
undercounted because death certificates may misclassify the cause of death as an accident
or identify the cause as underdetermined. Pressure to misreport a suicide as an
undetermined death stems from the disgrace or shame that still surround suicide and mental
illness problems, in general. This stigma of suicide places a cruel burden on surviving family
members and friends, who may, in hiding a suicide, be left to mourn in silence and secret.
The Kansas Response
The Kansas State Suicide Plan is grounded in principles, consistent with the eleven goals of
the Surgeon General’s National Strategy for Suicide Prevention (2001), highlighting the need
1) Enhance the development of comprehensive information on suicide, including the
incidence of suicidal thoughts and actions within state regions and among key risk groups,
the willingness and unwillingness of Kansans to seek competent help for suicidal crises, and
other important suicide-related information (National Strategy Goals 3, 10 and 11),
2) Construct a strategy within the state that allows for the systematic development of
information over time, with projects that build and strengthen a coordinated state plan (NS Goal
3) Provide support and information within each county, tailored to regional needs, for all key
risk subgroups within the state and identify and publish existing resources in each county (NS
4) Strengthen community, provider and school identification and responsiveness to the
unique forms of suicidal risks within their city, town or rural area (NS Goal 4).
5) Promote the development and use of evidenced-based suicide prevention interventions,
tailored to the risk groups involved, designed with cultural and age-group competence, and
capable of being delivered consistently and effectively (NS Goals 1, 2, 3 and 4),
6) Initiate training within the state to improve the mental health interventions for suicide (NS
Goals 7 and 8),
6) Increase the ability of healthcare providers to initiate referral and suicide prevention (NS
7) Improve the ability of crisis workers and first responders to intervene competently (NS Goal
2, 4, 7 and 8)
8) And, include coordinated outcome measurements of all plan activities (NS Goal 10).
An Information-Driven, Empirical Approach to Create a
Sustained Reduction of Suicide in the State
I. An Information-Driven Coalition.
This plan is designed to create a system of information gathering, community involvement,
intervention and outcome assessment that can lead to long-term improvement in suicide
awareness, increased access to care, increased willingness by Kansans to go for treatment,
enhanced quality of clinical intervention and reduced suicide and suicidal behavior in the
state of Kansas. This plan will foster a system in the state whereby information on the
activities and practices of Kansans will be used to guide the development of suicide
prevention strategies coordinated by the Subcommittee for Suicide Prevention (of the
Governor’s Mental Health Planning Council). These strategies will then be empirically
evaluated and, in turn, lead to modifications, new strategies and an evolving state plan as
reflected in Figure 1.
Figure 1. An Information-Driven State Suicide Prevention Plan
1. Information 2.Coalition 3.Strategies
6 months 3 months 3-9 months
4. Evaluation of Strategies
A. An Empirical Approach to Suicide Prevention. This plan will focus on variables inherent
in the relationship between characteristics of a person in crisis, the help a person in crisis
might need and the help available to them. This relationship is depicted in Figure 2, the Help
Figure 2. The Help Pathway Model
System and Context of the Crisis
Needing Help Available
Attitudes about Stigma of Mental
Getting Help Illness
Life Stresses Access to Care
Personality Types Quality of Care
It is hypothesized that understanding genetic and personality differences in individuals,
stresses they suffer and coping skills they may or may not posses can help enhance early
recognition of at-risk individuals. But, even with this knowledge, it is important to understand
the reasons that persons may or may not seek help for the depression and suicidal crises in
which the vulnerable person finds him or herself. Attitudes about mental illness and the
quality and effectiveness of the help available to them also factor in the success of any
possible intervention and the persistence that individuals demonstrate in re-mediating their
risk over time.
This plan begins with a strategy to enhance information about incidence, attitudes, beliefs,
practices and risk factors that relate to suicidal behavior in the State of Kansas. Information
will be gathered from a range of sources.
II. Development of a State Center for Information and Strategies on Suicide Prevention:
A state Center for Information and Strategies on Suicide Prevention needs to be developed
and funded to provide a centralized, organized entity for the development and dissemination
of information on suicide prevention. This center should develop a coordinated state plan to
support each region of the state. Further, specific information should be gathered and
organized in this center, and include:
A. Existing State Suicide Prevention Information: Information about suicide attempts and
suicide deaths will be gathered from existing state databases, emergency rooms and
insurance and health care sources.
B. Collection of Information within the State: A stratified random sample of Kansas
residents will be generated from 2000 Census information reflecting each geographic area of
the state and the appropriate proportions of women, different ages groups, and ethnic
diversity of the state. These Kansans will then be invited to participate in surveys about their
backgrounds, stresses, potential depressive and suicidal symptoms, attitudes toward getting
help for these problems and attitudes about mental health treatments that they may or may
not be willing to access.
Northwest Region Northeast Region
Mostly Rural Urban, Suburban, Rural
Mostly Caucasian Ethnic Diversity
Poor MH Resources Greater MH Resources
State Center for
Southwest Region Suicide Prevention Southeast Region
Mostly Rural Urban, Suburban, Rural
Caucasian/Hispanic Caucasian/Some Diversity
Poor MH Resources Moderate MH Resources
C. Collection of Information about Existing Suicide Prevention: Information will also be
collected on existing suicide identification and prevention efforts within the state, including
sources such as schools, geriatric and aging services, mental health providers, advocacy
coalitions, health departments, correctional facilities, crisis services, hospitals, emergency
rooms, etc. This information will be organized in terms of regional resources and activities.
D. Collection of Information on Plan Outcomes: Finally, outcome information will be
collected on the range of prevention and intervention initiatives supported by the state plan.
Enhanced county-by-county surveillance will be investigated by reviewing existing coroner
information for suicidal deaths and health data for emergency room and hospital information
about suicide and related issues. Ultimately, a county-by-county outcome system needs to
As additional funding becomes available, psychological autopsies may be of value in
developing individualized, regional prevention planning that includes family, community,
mental health and health care sources of information.
III. The Community and Regional Planning Initiatives:
As information is collected around the state, this information will be shared with regional
planning groups. New information to be collected will be identified, based on these regional
findings and these regional needs. In turn, as existing suicide initiatives are identified, these
groups will be invited to become partners in state initiatives and the overall state plan.
Support will be provided for these existing groups to utilize state plan outcomes, so that their
efforts add to the overall state planning and outcome process (see Figure 4).
Figure 4. Regionalized State Suicide Planning
Northwest Region Northeast Region
Mostly Rural Urban, Suburban, Rural
Mostly Caucasian Regional Plan Regional Plan Ethnic Diversity
Poor MH Resources #1 #2 Greater MH Resources
Southwest Region Southeast Region
Mostly Rural Regional Plan Regional Plan Urban, Suburban, Rural
Caucasian/Hispanic #3 #4 Caucasian/Some Diversity
Poor MH Resources Moderate MH Resources
Suicide Plan Goals and Objectives
The awareness goal is to enhance community awareness that suicide is a public health and
mental health problem, promote positive media efforts, improve state policy initiatives that
support efforts to reduce suicide, facilitate the use of empirically-validated prevention efforts
and ultimately, to understand the factors impacting Kansans’ willingness or unwillingness to
seek help in the event of a crisis. All information to be used in developing awareness will be
supported through information collected for the information-driven coalition process.
Awareness Objective 1: Enhance Kansan’s awareness that suicide is a public health and
mental health problem (coordinated through the Center for Suicide Prevention)
Awareness Objective 2: Improve state policy initiatives to reduce suicide
Awareness Objective 3: Facilitate the use of empirically-validated prevention efforts
Awareness Objective 4: Understand the factors impacting help seeking
Awareness Objective 5: Improve media support and media education for suicide prevention
The intervention goal is to utilize the information collected in the information-driven coalition
process to support empirically-validated prevention and intervention activities.
Intervention Objective 1: Based on local community information, promote suicide prevention
initiatives that can utilize appropriate community resources and community members (clergy,
school officials, parents, employers, etc.).
Intervention Objective 2: Reduce risk factors and promote factors that reduce the risk of
Intervention Objective 3: Build the capacity of mental health providers to provide quality,
effective, culturally-sensitive care for suicide ideation.
Intervention Objective 4: Strengthen crisis services and first responder skills.
Intervention Objective 5: Increase the ability of healthcare providers to enact referral and
Intervention Objective 6: Change Kansans’ willingness to seek help in the face of a suicidal
The methodology goal is to build a systematic, empirically-driven, evolving plan to reduce
suicide in the State Kansas. This methodology will be formulated to build collaboration
among all regions, counties and communities of the state, to foster research and education
about suicide and related issues and to increase scientific knowledge about how to prevent
Methodology Objective 1. Establish an Oversight Committee for state plan activities and
strategy development consisting of a broad, diverse group of persons reflecting political,
educational, correctional, health, social services, faith community, mental health, survivor,
and general community backgrounds and perspectives.
Methodology Objective 2. Establish a Prevention Practitioner and Scientific Committee to
organize collection of State Plan information for presentation to the Oversight Committee and
provide support for grant applications and funding solicitation.
Methodology Objective 3. Develop methods of information gathering to assess the
occurrence of suicide attempts and suicide completions in the Stat of Kansas.
Methodology Objective 4. Provide technical support and outcome promotion for prevention
activities two each of the four regions in the state.
Methodology Objective 5. Encourage the development of scientific knowledge in suicide
prevention activities within the state and the establishment of research partnerships.
Methodology Objective 6. Establish an on-going funding plan to facilitate state plan activities
The National Strategy for Suicide Prevention (2001)
Goal 1: Promote Public Awareness about Suicide as a Problem
Goal 2: Develop Broad-Based Support for Suicide Prevention
Goal 3: Develop Strategies to Reduce Stigma of Mental Health
Goal 4: Develop and Implement Community Suicide Prevention
Goal 5: Reduce Access to Lethal Means
Goal 6: Implement Training for Recognition of At-Risk Behavior
and Delivery of Effective Treatment
Goal 7: Develop and Promote Effective Clinical and Prof. Services
Goal 8: Improve Mental Health and Substance Abuse Linkages
Goal 9: Improve Reporting about Suicide In the Media
Goal 10: Promote Research
Goal 11: Improve and Expand Surveillance Systems