Perspectives on suicide prevention in health and behavioral health systems have widened in recent years from focusing primarily on the skills and practices of individual providers to now taking in the goal of creating a suicide-safer healthcare system as a whole. This movement has been inspired by other quality initiatives in healthcare that aim to eliminate medical errors, improve continuity, and improve organizational innovation by reducing the occurrence of preventable outcomes. In the field of suicide prevention, this movement has included the aspirational goal of ‘zero suicides’ in care.

Suicide among youth is a major public health concern globally. According to the WHO, suicide is the second leading cause of death in the world for 10–29-year-olds. It is important to recognize that young people are more likely to die by suicide than by any other single medical illness, underscoring the need for increased emphasis on medical education regarding suicide and the potential lifesaving impact of identification and effective care for youths with elevated suicide risk. Because suicidal ideation and behavior tend to have their first onsets during adolescence, this developmental period may offer an important window of opportunity to prevent the development of suicidal thoughts and behaviors, which lead to elevated risk of premature death, mental health and functioning problems, and psychological pain and distress.

Working with people at risk of suicide is rewarding, but difficult at times. When someone’s life may be at risk, clinicians often feel nervous and concerned, both for the patient and for themselves. In Chapters 5 and 6 we looked at how to form a connection with an at risk person and how to formulate an assessment of their risk relative to other groups and to themselves at other times. In this chapter we consider what constitutes a good response to this risk.by suggesting four categories that can be used to organize the planning, implementation, and documentation of responses to suicide risk. Having a clear framework for what constitutes a solid response ensures consistent care is comforting for patients, families, and providers.

Information about specific risk and protective factors for assessments are presented in Chapter 4. In this chapter, we present selected clinical considerations for integrating and synthesizing information gathered about well-known risk factors so that it can be used to improve our understanding of the individual person and drive plans and responses.

In recent years in the USA, UK, and many other areas around the world, awareness of suicide risk in LGBTQ youth as well as across the lifespan has increased considerably. While these advances are critically important, stigma reduction occurs at different paces, unevenly around the world, and, even within small communities, widely varying attitudes exist. Therefore, while progress has been profound in many places, there is much work still to be done to eradicate stigma.

As a healthcare provider, consider taking special notice of your patients who are veterans or active duty service members. You may be the only caregiver poised to recognize suicide risk in your patients who have served. Consider always asking patients, “Have you ever served in the military?” or “Have you ever worn the uniform?” (Some veterans do not know they qualify as a veteran and therefore it may not be effective to ask, “Are you a veteran?”)

Although suicide in other demographic groups may receive more public attention, suicide among older adults has long been an intense target of concern for suicide prevention. In fact, in most populations and regions of the world, suicide rates are highest in older or middle age adults. Older adult suicide is also an area where the suicide prevention field has learned a lot about successful prevention programs that utilize a combination of clinical and social/community programs.