Suicide Prevention is a Multi-Level Strategy

Effective programs can reduce the number of deaths by suicide. Know the clear action steps for people, communities, and policymakers.

Suicide is a Major Public Health Concern

1,600+

people died by suicide in North Carolina in 2022

14,500,000+

total calls, texts, and chats to the 988 Lifeline since 2022

See More on the Impact of Suicide

How Does Prevention Work?

The graphic below shows a useful model of suicide prevention. A suicide attempt is like a waterfall in a stream. Prevention work can happen far upstream, near the waterfall, or downstream. Those levels can also be called primary (upstream), secondary (midstream), and tertiary (downstream).

Primary or Upstream Prevention — builds protective factors and reduces suicide risk

Secondary or Midstream Prevention — intervenes for emerging suicide risk and provides supports to avoid suicidal crisis

Tertiary or Downstream Prevention — provides compassionate responses when a suicide crisis happens to reduce the impact of thoughts of suicide, suicide attempts, and suicide loss

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Primary prevention addresses the root causes of suicide. This includes trauma, the ongoing mental health crisis, poor access to health care, and other risk factors.

An image of a stream that shows how suicide prevention happens on three levels -- primary (upstream), secondary (midstream), and tertiary (downstream).

Examples of primary prevention (upstream) strategies include:

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Secondary prevention identifies people who face emerging risks. It also intervenes to keep them safe and connects them to the right supports to prevent a suicidal crisis.

An image of a stream that shows how suicide prevention happens on three levels -- primary (upstream), secondary (midstream), and tertiary (downstream).

Examples of secondary prevention (midstream) strategies include:

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Tertiary prevention guides the response to suicidal crises. It also promotes approaches to these crises that have connection, dignity, and empowerment (and not fear).

An image of a stream that shows how suicide prevention happens on three levels -- primary (upstream), secondary (midstream), and tertiary (downstream).

Examples of tertiary prevention (downstream) strategies include:

Resources on Suicide Prevention

Use these resources to find more action steps and strategies on suicide prevention.

Courses

Free courses on topics around suicide prevention.

LivingWorks Suicide Prevention Trainings

Evidence-based training that empowers individuals, organizations and communities to work together to help keep people safer from suicide.

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How to Find Help Right Now

If you or someone else needs help right now, do not wait. Use these resources below to get help.

988

Lifeline

Available 24/7/365. Free. Confidential.
Connect to judgment-free counselors who provide compassionate support.

Free and confidential. Available 24/7/365. Staffed by trained crisis counselors who can help you take care of yourself, a friend, or loved one.

Free and confidential. Available 24/7/365. Connect with a real, qualified person who can support veterans and family members. You don’t have to be enrolled in VA benefits or health care to call.

Free and confidential. Available 24/7/365. Trained counselors who understand the challenges LGBTQ+ young people face and provide judgement-free support.

Free and confidential. Available 24/7/365. Exclusively for current and former law enforcement personnel and their families. Staffed by trained and compassionate retired officers.

Free and confidential. Open Monday-Friday from 1:00pm-9:00pm. Staffed by trans/nonbinary peer operators. No nonconsensual active rescue.

Free and available 24/7/365 (English only). Staffed by certified peer support specialists who have personal experiences with mental health or substance use issues.

Free and confidential. Open Monday-Friday from 8:30am-5:00pm. Trained staff and volunteers can help individuals and family members who are impacted by mental health concerns.

Free and confidential. Available 24/7/365. Staffed by trained Community Resource Specialists who can make referrals to verified resources for basic needs such as housing and utility assistance, food, health care, transportation, and more.

Free and confidential. Available 24/7/365 in English and Spanish. It serves individuals and family members who face mental and/or substance use disorders and offers referrals to local treatment options, support groups, and community-based organizations.

Free and confidential. Available 24/7/365 in multiple languages. Staffed by trained counselors and open to anyone who experiences emotional distress related to disasters (survivors, loved ones, first responders, clergy, rescue and recovery workers, and more).

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