How Employers Can Advance the 2024 National Strategy for Suicide Prevention

Posted on by Hope M. Tiesman, Eric G. Carbone, John Malgeri, L. Casey Chosewood

 

Suicide is a serious public health threat. In 2022 in the United States, nearly 50,000 adults died by suicide, 13.2 million adults seriously considered suicide, 3.8 million planned a suicide attempt, and 1.6 million attempted suicide.[1] In that same year, 267 adults died by suicide while at work in the United States.[2] That is one person dying in the workplace by suicide every workday in a year. People in certain occupations are at an increased risk for suicide, which makes the workplace an important potential intervention site because many adults spend a significant amount of time at work.  Employers and workplaces can play a vital role in suicide prevention.

In 2001, the first National Strategy for Suicide Prevention was released and was updated in 2012 by Surgeon General Dr. Regina Benjamin and the National Action Alliance for Suicide Prevention. In April, the Biden Harris Administration, through the U.S. Department of Health and Human Services (HHS) released the 2024 National Strategy for Suicide Prevention which acknowledges major advancements since 2012, recognizes existing gaps and emerging issues, and calls for a more coordinated and comprehensive public health approach to suicide prevention.[3] The National Strategy is built around four Strategic Directions: (1) Community-Based Suicide Prevention; (2) Treatment and Crisis Services; (3) Surveillance, Quality Improvement, and Research; and (4) Health Equity in Suicide Prevention.

The 2024 National Strategy focuses more on the role of work and workplace culture and calls for expanded workplace efforts in preventing suicide and assisting workers at risk. The National Strategy discusses how employers can integrate suicide prevention into the culture of their workplace by implementing effective policies, programs, and practices that prioritize employee well-being, help-seeking, and connectedness as part of suicide prevention planning efforts. Employers are an important partner in suicide prevention efforts. There are 15 goals under the 4 Strategic Directions in the National Strategy and in this blog, we highlight 5 goals that are applicable to the workplace.

Strategic Direction 1: Community-Based Suicide Prevention

Strategic Direction 1 centers on community-based suicide prevention activities to prevent the onset of suicide risk. Communities are crucial for suicide prevention and include workplaces. There are seven goals under this Strategic Direction. Goal 5 under the first Strategic Direction specifically addresses workplaces. Goal 5 is ‘Integrate suicide prevention into the culture of the workplace and into other community settings.’ Suicide prevention can add to a culture of well-being. Senior leaders, managers, and supervisors can, in a coordinated manner, foster a supportive culture to reduce stigma and encourage employees who are experiencing difficulties to seek help. Employers can promote suicide prevention awareness and training at all levels of an organization so that employees can learn to recognize signs of distress early.

Under this Strategic Direction, there are 6 other goals. Goal 4 is ‘Conduct postvention and support people with suicide-centered lived experience (people who have experienced the death of a loved one due to suicide).’  The impact of suicide can be far-reaching. For each suicide death, 135 people are exposed to that death and may need mental health services or support.[4] In fact, experiencing the suicide of a close friend or family member is a risk factor for suicide. Postvention, defined as formal and informal help and support provided to people bereaved by suicide, can counteract this potential impact. Postvention activities both promote healing after a suicide and reduce future risk. Suicide bereavement groups are one common postvention service.[5]

Postvention is a vital part of an overall public health model to prevent suicide, and employers can play a significant role. In 2013, suicide experts and suicide organizations including the American Association of Suicidology, the Action Alliance for Suicide Prevention, and the Carson J Spencer Foundation developed the Managers Guide to Suicide Postvention in the Workplace. The guide provides steps for employers to first respond to the traumatic event, then help develop a short-term recovery plan, and finally think about longer-term strategies for coping. The guide has 10 clear action steps with procedures, checklists, and flow charts for employers and workplaces.

Strategic Direction 2: Treatment and Crisis Services

Strategic Direction 2 calls for a systematic approach to suicide care in U.S. healthcare systems and has two goals. Goal 8 is ‘Implement effective suicide prevention services as a core component of health care.’ Employee Assistance Programs (EAPs) are voluntary, employer-sponsored programs that help address a broad set of issues impacting employees’ mental health such as substance use and misuse, stress, grief, family issues, and mental health conditions.[6] In short, EAPs deliver free and confidential mental health support to employees and their families as part of the overall U.S. healthcare system. While EAP services vary greatly, EAPs have the potential to provide suicide awareness training, individual assessments, intervention and counseling, treatment referrals, and postvention services to workplaces. One of the most common barriers to mental health treatment is access and cost. An important benefit of EAPs is the removal of this barrier for people experiencing a mental health crisis.[7]

EAPs are available to employees in approximately 78% of businesses in the public sector and 51% of private sector organizations but vary based on size of the business.[8] While it can be difficult to study the effect of EAPs on employee mental health, some research suggests that EAPs can reduce suicidal thoughts and depression.[9] This widespread use of EAPs by companies provides an existing framework to deliver effective suicide prevention programs and resources. There are different types of EAPs based on who they serve. EAPs can be located onsite, an external program that employees access to schedule appointments, or a hybrid.[10]

To support employees use of EAP suicide prevention and other mental health services, employers can be thoughtful and strategic when selecting an EAP vendor. Questions such as the nature of the industry, the profile of the employees, and considerations of the cultural and ethnic diversity should be explored. The Workplace Suicide Prevention group developed 15 questions to help guide employers when evaluating EAP vendors as it relates to suicide prevention.

Unfortunately, EAPs are highly under-utilized by employees. Larger organizations see an average EAP utilization between 10% and 15%.[11]  Many reasons may explain this finding including stigma, confidentiality concerns, and lack of awareness of the organization’s offerings. Employers can address these barriers by expanding EAP benefits to include web, text, and phone-based options. They can also boost awareness of a company’s EAPs by frequent communication such as lunch and learns, emails and/or newsletters, as well as openly addressing confidentiality concerns. Employers can also offer their employees the opportunity to provide confidential and anonymous assessments of the quality of EAP services and programs.

Strategic Direction 3: Surveillance, Quality Improvement, and Research

Strategic Direction 3 focuses on improving data on suicidal thoughts, attempts, deaths, as well as risk and protective factors. Surveillance of these factors allow researchers to better track changes in suicide over time. There are two goals under this strategic direction. Goal 10 is ‘Improve the quality, timeliness, scope, usefulness, and accessibility of data needed for suicide-related surveillance, research, evaluation, and quality improvement.’ One current challenge of studying suicide risk among workers is the lack of risk factor data in common occupational safety and health databases and until recently, the lack of standardized industry and occupation coding in databases used for suicide research.

Information about a person’s occupation and industry can be incredibly useful for determining if certain jobs or kinds of businesses put people at a higher risk for suicide. Based on systematic reviews, population-based surveillance, and government reports, some occupations at high-risk for suicide include first responders, veterinarians, construction workers, healthcare workers, and military service members.[12],[13] One of the most comprehensive databases available to study suicide mortality is the National Violent Death Reporting System. Recently this database started using the National Institute for Occupational Safety and Health (NIOSH) Industry and Occupation Computerized Coding System to code industry and occupation. Adding industry and occupation information in this suicide surveillance system will support researchers in better understanding suicide risk among workers in diverse occupations and industries. However, other databases used for suicide research including the National Survey on Drug Use and Health and the National Electronic Injury Surveillance System – All Injury Programs do not yet include occupation or industry.

Work-related psychosocial hazards are factors in the work environment that can cause stress, strain, or interpersonal problems for the worker and are associated with suicidal ideations.[14] The United States currently has limited surveillance of these hazards, even though national surveillance has been recommended.[15] Some questions have been added to existing surveillance tools such as the 2021 NIOSH Worker Well‐Being Survey, the Harvard “Thriving” questionnaire, the NIOSH Quality of Worklife Questionnaire, and to a lesser extent the National Health Interview Survey. Nevertheless, there is still a need for improved and expanded monitoring at both the organizational and national level.

Strategic Direction 4: Health Equity in Suicide Prevention

Strategic Direction 4 calls attention to populations that have been disproportionately impacted by suicide and includes 4 goals. Goal 15 isImprove and expand effective suicide prevention programs for populations disproportionately impacted by suicide across the life span through improved data, research, and evaluation.’ Workers spend a significant amount of time at work and this allows co-workers and supervisors to potentially notice changes in thoughts or behaviors, as well as to provide social or emotional support. Also, for some high-risk groups, work may be the only location for delivery of effective suicide prevention resources or intervention.

However, in suicide prevention efforts, the workplace has largely been ignored. There are very few workplace suicide prevention programs with data on effectiveness. Over a 22-year period, only 36 workplace suicide interventions were found in the scientific literature.[16] If the military sector is removed, only 24 interventions have published scientific data on their effectiveness.16 And of these, the vast majority were performed outside of U.S. workplaces—which is an important limitation given the differences in work cultures across countries. Even so, the bulk of the evidence suggests that workplace suicide prevention programs can have a positive impact on suicide attitudes and beliefs, as well as reduce suicide risk.[16]

Workplace efforts to prevent suicide are ideally customized to the needs of the workers within the organization and within their industry. What works in one occupation or industry may not work in another. Some general strategies that positively impact most workplaces include providing confidential peer support, increasing access to mental health services, limiting access to lethal means, and reducing stigma to encourage easier access to quality care.[17] More research is needed on the development and evaluation of workplace suicide prevention programs in the United States using well-designed experimental studies. This would help strengthen the evidence base on workplace suicide prevention programs.

Conclusion

Employers and workplaces can play a vital role in suicide prevention. We have outlined some steps above to help employers contribute to the more coordinated and comprehensive public approach to suicide prevention outlined in the 2024 National Strategy for Suicide Prevention. We hope these steps will lead to better utilization of the workplace in suicide prevention. If you or someone you know needs help, call or text 988 or chat 988lifeline.org. 988 connects you with a trained crisis counselor who can help.

 

Hope M. Tiesman, PhD, is a Research Epidemiologist in the NIOSH Division of Safety Research. She is the Co-Chair of the CDC Mental Health Scientific Workgroup, and sits on the Workplace Suicide Prevention and Postvention Committee.

Eric G. Carbone, MBA, PhD, is a licensed clinical psychologist and Chief, Surveillance & Field Investigations Branch in the NIOSH Division of Safety Research. He represents NIOSH on the National Strategy for Suicide Prevention Interagency Workgroup.

John Malgeri, JD, PhD, is the Senior HR Program Advisor for the U.S. Secret Service and serves as the Co-Chair of the Federal Mental Wellbeing Community of Practice.

L. Casey Chosewood, MD MPH, is Director of the NIOSH Office for Total Worker Health®.

 

Resources

Suicide and Occupation | NIOSH | CDC

Total Worker Health | NIOSH | CDC

Suicide Prevention Resource for Action | Suicide | CDC

Suicide Prevention: 5 Things You Should Know (osha.gov)

Free Resources for Employers:

References

[1] Centers for Disease Control and Prevention [2024]. Suicide Prevention. Website.  https://www.cdc.gov/suicide/facts/index.html

[2] Bureau of Labor Statistics [2023]. Economic News Release. Census of Fatal Occupational Injuries Summary, 2022.
https://www.bls.gov/news.release/cfoi.nr0.htm

[3] U.S. Department of Health and Human Services (HHS), National Strategy for Suicide Prevention. Washington, DC: HHS, April 2024.

[4] Cerel J, Brown MM, Maple M, Singleton M, van de Venne J, Moore M, Flaherty C. How Many People Are Exposed to Suicide? Not Six. Suicide Life Threat Behav. 2019 Apr;49(2):529-534.

[5] Andriessen K, Krysinska K, Kõlves K, Reavley N. Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review. Front Psychol. 2019 Nov 29;10:2677

[6] U.S. Office of Personnel Management. Employee Assistance Program.  Employee Assistance Program Questions and Answers. https://www.opm.gov/frequently-asked-questions/work-life-faq/employee-assistance-program-eap/what-is-an-employee-assistance-program-eap

[7] Joseph B, Walker A, Fuller-Tyszkiewicz M. Evaluating the effectiveness of employee assistance programmes: a systematic review. Eur J Work Organ Psy. 2018;27(1):1–15. https://doi.org/10.1080/1359432X.2017.1374245

[8] Attridge M. Profile of Small Employers in the United States and the Importance of Employee Assistance Programs During the COVID-19 Pandemic. Am J Health Promot. 2022 Sep;36(7):1229-1236

[9] Nakao M, Nishikitani M, Shima S, Yano E. A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers. Int Arch Occup Environ Health. 2007 Nov;81(2):151-7.

[10] Substance Abuse and Mental Health Services Administration [2023]. Provide Support Employee Assistance Programs. https://www.samhsa.gov/workplace/employer-resources/provide-support

[11] Attridge, M. (2023). The Current State of Employee Assistance Programs in the United States: A Research-based Commentary. International Journal of Scientific and Research Publications, 13(8), 74-91.

[12] Germain, M.-L. (Ed.) (2025). Occupational Suicide: Coping strategies for Employees and Corporate Leaders. Palgrave MacMillan.

[13] Sussell A, Peterson C, Li J, Miniño A, Scott KA, Stone DM. Suicide Rates by Industry and Occupation – National Vital Statistics System, United States, 2021. MMWR Morb Mortal Wkly Rep. 2023 Dec 15;72(50):1346-1350.

[14] Niedhammer I, Pineau E, Rosankis E. The associations of psychosocial work exposures with suicidal ideation in the national French SUMER study. J Affect Disord. 2024 Jul 1;356:699-706.

[15] Schulte PA, Sauter SL, Pandalai SP, Tiesman HM, Chosewood LC, Cunningham TR, Wurzelbacher SJ, Pana-Cryan R, Swanson NG, Chang CC, Nigam JAS, Reissman DB, Ray TK, Howard J. An urgent call to address work-related psychosocial hazards and improve worker well-being. Am J Ind Med. 2024 Jun;67(6):499-514.

[16] Hallett N, Rees H, Hannah F, Hollowood L, Bradbury-Jones C. Workplace interventions to prevent suicide: A scoping review. PLoS One. 2024 May 2;19(5):e0301453

[17] Tiesman H, Frey J, Spencer-Thomas S, [2023]. Critical Steps Your Workplace Can Take Today to Prevent Suicide. NIOSH Science Blog. March 15, https://blogs.cdc.gov/niosh-science-blog/2023/03/15/preventing-workplace-suicide/

 

 

Posted on by Hope M. Tiesman, Eric G. Carbone, John Malgeri, L. Casey Chosewood

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Page last reviewed: September 27, 2024
Page last updated: September 27, 2024