We count suicide deaths. We calculate rates, compare counties and states, and publish annual reports. We are awash in numbers. Numbers are cold things; lives lost to suicide are not.
The numbers are necessary. But we know more about the people we have lost than about our readiness to prevent the next death.
Suppose you are a county public health director. Can you answer these questions? How many people are currently trained to recognize suicide warning signs? Where are they? Are they using their training? Are some communities largely unprotected?
In most counties, answering would be difficult. I believe we can change that.
What public health already knows
When measles appears, public health officials do more than count cases. They investigate exposure, examine vaccination coverage, identify vulnerable populations, and mobilize resources.
Suicide is not an infectious disease. Although exposure to suicidal behavior can influence risk under some circumstances (CDC, 2024), the comparison here concerns public health readiness: identify the threat, measure protective capacity, find the gaps, and intervene.
Our community safety network includes teachers, coaches, parents, coworkers, clergy, healthcare workers, first responders, peer supporters, friends, and neighbors. It also includes bartenders, hairdressers, lawyers, and anyone who feels responsible for someone in distress.
I propose that counties measure four indicators of this network’s readiness.
Four measures of readiness
Coverage. How many people are currently trained, and how well are they distributed across the places where people live, work, learn, pray, and seek help? Training totals alone cannot reveal unprotected communities.
Training currency. How many have maintained their knowledge and skills? People change jobs, move, retire, or forget what they learned. The number ever trained differs from the number ready to act today. As with other emergency-response skills, readiness should be refreshed and measured.
Intervention activity. Are trained people recognizing distress, asking about suicide, and taking appropriate action? Participation statistics do not tell us whether training is being used. Brief, confidential follow-up surveys could help answer that question.
Successful connections. Referral is an action. Connection is an outcome. Waiting lists, transportation, costs, and unfamiliar services can prevent a referral from becoming help. When I directed a large public mental health service, I tracked completed referrals from our inpatient units to outpatient care. I aimed for 100%. We could achieve over 90% when we put enough effort into helping people connect.
Together, these measures would tell us far more about prevention capacity than training totals alone.
A Community Suicide Prevention Readiness Index
These indicators could form a proposed Community Suicide Prevention Readiness Index, or CSPRI. Its purpose would be to measure preparedness, not predict suicide mortality. Common definitions, data-quality checks, and validation would be essential.
Imagine a dashboard showing strong coverage in schools but few trained gatekeepers in workplaces and rural communities. That tells us where to concentrate training. If interventions are common but completed connections are rare, we need to improve the pathway to care.
The dashboard does not simply congratulate us for what we have done. It tells us what we need to do next. Mortality and emergency-department data remain important; readiness measures add a picture of the community’s capacity to respond before a crisis becomes fatal.
Counties could also recognize improvements in coverage, training currency, intervention activity, and connections. A rural county doubling its coverage might deserve as much recognition as a metropolitan county sustaining a strong program.
Who would maintain it
A designated suicide prevention coordinator could maintain the dashboard through county, regional, or state public health arrangements, working with schools, hospitals, employers, behavioral health providers, crisis services, and community organizations.
The county would not have to provide every training or intervention. Its responsibility would be to understand and strengthen the local safety network.
Keep reporting manageable. Training providers, brief anonymous surveys, and voluntary reporting partnerships could supply aggregate information without personally identifying information.
Awareness is not readiness
A community can know suicide is a problem and still have too few people prepared to respond. It can have excellent clinical services while failing to identify people who need them.
We are never going to produce enough mental health professionals to be present whenever and wherever suicidal crises emerge. We must strengthen ordinary people’s capacity to recognize distress and begin helping. Breaking through loneliness and isolation does not always require a professional license.
How counties are paying for prevention
Readiness cannot depend indefinitely on short-term grants and a few enthusiastic people. Communities need dependable financing for training, recertification, coordination, and evaluation. Three counties offer different examples.
In McHenry County, Illinois, voters approved replacing a Mental Health Board property-tax levy with a 0.25% sales tax in 2024. The county reported approximately $11.2 million in board sales-tax revenue in 2025, exceeding the former levy. This supports mental health services broadly, not suicide prevention alone.
In Yolo County, California, Mental Health Services Act funding has supported prevention and early intervention, including QPR gatekeeper training. California’s transition to the Behavioral Health Services Act will change funding arrangements.
In Boulder County, Colorado, voters approved a three-year 0.15% sales and use tax in November 2025 for mental and behavioral health. Its purposes explicitly include suicide prevention and intervention, crisis services, treatment, and recovery.
These are financing examples, not proof that taxes reduce suicide mortality. A dedicated tax, levy, or recurring appropriation could support gatekeeper training, annual recertification, advanced Pathfinder training, a coordinator, and a modest dashboard. The dashboard could help answer a taxpayer’s reasonable question: What are we getting for our investment?
We finance readiness for fires and medical emergencies before they occur. Why leave readiness for suicidal distress to chance?
A proposal for America’s counties
Begin with coverage, training currency, intervention activity, and successful connections. Measure what we can now. Build partnerships to collect what is missing. Test the measures, improve them, and share what we learn.
A validated national index may eventually permit meaningful comparisons. The first step requires neither sophisticated software nor a large research grant. It requires asking:
How ready are we to prevent the next suicide?
We count the lives we lose. It is time we also count, strengthen, and sustain the people prepared to save them.
Preventing suicide, it’s what people do.
References
Burnette, C., Ramchand, R., & Ayer, L. (2015). Gatekeeper training for suicide prevention: A theoretical model and review of the empirical literature. RAND Health Quarterly, 5(1), 16.
Centers for Disease Control and Prevention. (2022). Suicide prevention resource for action: A compilation of the best available evidence. U.S. Department of Health and Human Services.
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 42(4), 386–405.
McHenry County Government. (2026, February 20). Mental Health Board sales tax a success. https://www.mchenrycountyil.gov/Home/Components/News/News/18563/17
Boulder County. (2025). 2025 ballot measures. https://bouldercounty.gov/government/county-ballot-measures/2025-ballot-measures/
Yolo County. (2023). MHSA program plan (QPR suicide prevention training). https://www.yolocounty.gov/home/showpublisheddocument/77965/638325314890530000
Yolo County. (2026). Behavioral Health Services Act & Mental Health Services Act. https://www.yolocounty.gov/government/general-government-departments/health-human-services/mental-health/mental-health-services/mental-health-services-act-mhsa/-folder-4947
Centers for Disease Control and Prevention. (2024). CDC guidance for community response to suicide clusters, United States, 2024. Morbidity and Mortality Weekly Report, 73(Suppl. 2). https://www.cdc.gov/mmwr/volumes/73/su/su7302a3.htm
AI research and editorial assistance
Quigley, my AI research and editorial assistant, helped identify public sources and assisted with editing this article. The ideas, interpretations, and final responsibility for the content are my own.
