Asking About Suicide Is Vital for Suicide Prevention, and Governments Can Lead the Way

Suicide is a problem everywhere — in every country, state, city, and town — and governments have the authority and opportunity to prevent it. In short, they can help save lives. The need is dire, as World Health Organization figures show.

Worldwide, suicide takes a life every 40 seconds and, in a typical year, is responsible for more deaths than war, homicide, and natural disasters combined.

Suicide is the No. 1 cause of death among 15- to 19-year-old girls worldwide, and the second leading cause of death among all people ages 15 to 29. In the U.S., more people die by suicide than in traffic crashes.

The Columbia Protocol Is Helping Governments Save Lives and Target Resources

Asking the right questions to identify who is at risk is a critical first step in suicide prevention. Many governments recognize this and have mandated or encourage the use of suicide risk screening for public schools and services, such as health centers, hospitals, and police departments. The Columbia Protocol — also known as the Columbia-Suicide Severity Rating Scale (C-SSRS) — is the ideal risk detection tool for these efforts because it’s:

  • Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them. That simplicity means governments can comfortably promote the protocol’s use in a variety of settings, knowing that it can be applied effectively without creating a burden.
  • Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research. This means governments are not imposing costs on programs and services that use the protocol.
  • Efficient. Use of the Columbia Protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly determine the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
  • Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol  to identify suicide risk, making it the most evidence-based tool of its kind.
  • Effective. Real-world experience and data show that the protocol has helped prevent suicide.
  • Universal. The Columbia Protocol  is suitable for all ages and special populations in different settings and available in more than 140 country-specific languages.


“As a parent who lost a son to suicide and a state legislator who helped pass a suicide prevention bill, I am deeply familiar with the vital importance of recognizing suicide risk as early as possible,” says Georgia Sen. Renee Unterman, chairwoman of the Health and Human Services Committee. “These deaths are preventable with the proper policies and practices — and the use of tools like the C-SSRS at schools, hospitals, doctors’ offices, law enforcement agencies, and more.”

Success Story

Columbia Protocol Helps Utah Reverse Statewide Rise in Suicide Rates

Suicide is a major public health problem in Utah, which has one of the nation’s highest age-adjusted suicide rates. According to the state’s Department of Human Services, suicide was the second leading cause of death among Utah residents ages 10–39 and the leading cause for youth ages 10–17 in 2013. A 2015 survey found that more than 14% of Utah’s students in grades 6–12 seriously considered suicide within the past year.

That’s why state lawmakers passed legislation requiring the Division of Substance Abuse and Mental Health to designate a state suicide prevention coordinator to organize suicide prevention efforts statewide — and provided $400,000 to support them.

“We are committed to becoming a Zero Suicide system of care,” the division said in a 2015 report. Zero Suicide, a key concept of the 2012 National Strategy for Suicide Prevention, is a commitment to suicide prevention in health and behavioral health care systems.

Utah’s “all-in” effort already includes emergency services, health centers, domestic violence shelters, child welfare agencies, and more. Identifying people at risk is a critical part of the effort.

The mental health division has described screening and assessment using the Columbia Protocol as “an important piece to this comprehensive multisystem approach,” and it has been highlighting the use of the Columbia Protocol  and subsequent interventions. As a public-private partnership, it helped Salt Lake City-based Intermountain Healthcare implement the Columbia Protocol  into a system that includes 22 hospitals and more than 185 clinics.

The state’s upward trend in suicides — a steady climb from 479 in 2010 to 582 in 2013 — changed course in 2014 with a decline to 555.

“Experts are citing the implementation of the Columbia-Suicide Severity Rating Scale, a six-question screening tool, in hospital emergency rooms and behavioral centers as a factor,” Sheila Leslie, former Nevada state senator, wrote in an April 2016 opinion piece imploring more Nevadans to follow Utah’s example and take proactive steps to prevent suicide. “More effective screening combined with access to mental health care are the key elements leading toward the goal of zero suicides.”

The C-SSRS in Action

The Columbia Protocol  has been mandated for use by top-down policy in over 20 U.S. states and incorporated into national strategies for suicide prevention, including in Israel and Kosovo.

States with policy-level implementation of the Columbia Protocol include:

  • California
  • Maine
  • North Carolina
  • Tennessee
  • Colorado
  • Maryland
  • Ohio
  • Utah
  • Connecticut
  • Michigan
  • Oklahoma
  • Washington
  • Delaware
  • New Jersey
  • Pennsylvania
  • Wisconsin
  • Georgia
  • New York
  • Rhode Island
  • Wyoming

“A national strategy indicates a clear commitment of a government to prioritizing and dealing with the issue of suicide.”

World Health Organization report, “Preventing Suicide: A Global Imperative”