“Issue Paper on Acute Suicidality” Demonstrates the Need for a Paradigm Shift in the Understanding of Suicide

DENVER, CO – Healthier Colorado released a new report, Issue Paper on Acute Suicidality: An Urgent Need for Systemic Change, shedding light on the rapid onset of suicide crises. While suicide is often thought of as the result of a prolonged struggle with mental illness, research reveals that suicidality can rapidly escalate within just minutes or hours. The report presents the need for a paradigm shift in the understanding of suicide, suicide risk, and suicide crises so that we can better recognize and address cases of rapid onset.

Suicide is a public health crisis in the United States. It is the 8th leading cause of death in Colorado and the 11th leading cause of death nationwide. Significant advancements have been made in suicide prevention, but our understanding of and ability to respond to cases of acute suicidality remain limited.

Acute suicidality is characterized by sudden onset without traditional warning signs or symptoms of underlying mental health conditions. Suicide without warning is not uncommon. A study that included interviews with survivors of near-fatal suicide attempts found that one in four reported contemplating suicide for less than five minutes, with only 13% reporting that they deliberated for one or more days. Another study of people who were seen in a hospital following a suicide attempt found that 48% reported that the time between first thinking about suicide and their suicidal act was less than 10 minutes.

When there is a sudden onset of suicidality, mainstream suicide screening tools are often insufficient. Additionally, family and community members cannot rely on traditional warning signs (like expressing a desire or plan to die, displaying mood swings, or withdrawing from others) to identify that a loved one might be at risk.

In order to address this gap in screening and prevention, the issue paper outlines several recommendations for research, practice, and policy, including:

1. Utilizing the data and research to advocate for a suicide-specific diagnosis to be included in diagnostic tools.
2. Prioritizing additional research around the proposed diagnoses, suicidal crises, and the onset of acute suicidality.
3. Partnering with clinicians to create new or improve existing screenings, assessments, and interventions.
4. Utilizing the proposed diagnostic criteria to educate new clinicians through higher education institutions, training institutions, and peer support models.
5. Building public awareness among community members, school staff, employers, and others that suicidality can affect anyone, even those with strong protective factors and no history of past mental health concerns.

“Suicide is a devastating and escalating crisis in our country. The emerging understanding we have about the rapid onset of suicidality only makes the need for action that more urgent,” said Christina Walker, Senior Director of Policy at Healthier Colorado. “Our hope is that this report will be the catalyst for changing the way we think about and respond to the mental health crises that far too many families have experienced.”

Issue Paper on Acute Suicidality: An Urgent Need for Systemic Change is the result of a two-day convening that took place in June 2024. Experts across policy, practice, research, and lived experience came together to better understand the phenomenon of acute suicidality and discuss proposals for action. The convening was co-hosted by Healthier Colorado and the Ash-Lignell family, whose son experienced an acute and catastrophic mental health crisis over the short course of days and tragically died in May 2021.

The full issue paper is available here.