Thanks to the efforts of Nebraska State Suicide Prevention Coalition, the Kim Foundation, and the University of Nebraska Public Policy Center, the 2024 Nebraska Suicide Prevention Summit was held on March 27, 2024, in Kearney, NE.
The event brought together 85 attendees, including experts and practitioners in suicide prevention, as well as community members with lived experience of suicide and suicide loss. Summit participants were invited to bring their expertise together to highlight successes, identify barriers, assess current efforts, pinpoint areas of need, and evaluate the sustainability of suicide prevention and postvention initiatives. They worked collaboratively with other attendees to propose actionable steps aligned with the objectives outlined in the Nebraska State Suicide Prevention Plan. The summit was divided into two segments, beginning with speakers and presentations, followed by a series of guided breakout discussions. Attendees heard from Dr. Ming Qu, Senior Epidemiologist/Data Scientist at the Nebraska Department of Health and Human Services (NE DHHS), who presented “Using Multiple Data Sources to Examine Trends and Disparities of Suicide in Nebraska 2017-2022” and provided suicide statistics for participants in context with linkages from various data sources. Dr. Ryan Carruthers, a Licensed Mental Health Practitioner (LMHP), Licensed Alcohol and Drug Counselor (LADC), and Certified Peer Support Specialist (CPSS) in the State of Nebraska, presented “Implementing Zero Suicide: An Agency-Level Lived Experience Perspective.” Speakers Kyle Kinney, an LMHP and the program manager of the 988 NE Suicide & Crisis Lifeline and the Nebraska Family Helpline, and Michelle Nunemaker, State Planner for the implementation of 988 in Nebraska, presented on “988 in Nebraska: Foundations, Collaborations, and Partnerships.” After the presentations and a networking lunch period, participants were invited to participate in a series of three themed breakout sessions to discuss 1) prevention strategies, 2) populations of concern, and 3) blue sky thinking on how to improve suicide prevention across systems in the state of Nebraska. Facilitators from the NUPPC helped guide discussion and capture information shared by participants that made up this summary report.
Proposed Challenge for 2025
Nebraska’s Suicide Prevention Coalition reviewed and discussed the insights and recommendations from summit breakout group participants. The coalition intends to incorporate these goals into ongoing prevention efforts.
Building on the themes identified during the 2024 summit, the coalition recognizes several key challenges for 2025, including:
Expand Prevention Programs
• Establish 10 new Hope Squads in rural Nebraska schools to promote peer-led suicide prevention and support efforts.
• Challenge QPR (Question, Persuade, Refer) and Mental Health First Aid trainers to each certify at least 30 individuals in 2025, increasing the reach of mental health education.
• Launch a statewide social media campaign targeting high-risk groups, with a focus on reducing stigma, promoting lethal means safety, and addressing other upstream protective factors.
• Enhance efforts to improve and measure protective factors at individual, community, and societal levels to reduce suicide risk.
Strengthen Collaboration
• Develop and share adaptable, action-oriented agendas for prevention coalitions to focus on effective suicide prevention and postvention practices.
• Foster inclusivity by ensuring that schools, hospitals, faith-based organizations, peer groups, behavioral health providers, public health districts, and other stakeholders are actively represented in prevention coalitions.
• Distribute 5,000 gun safety devices (e.g., lockboxes) and/or medication disposal kits through partnerships with community organizations to promote safe storage practices.
Promote Lethal Means Safety and Security
• Promote lethal means safety through coordinated campaigns featuring tools, educational materials, and trainings such as CALM (Counseling on Access to Lethal Means) and CALM Conversations, aimed at reducing access to lethal means in crisis situations.
Increase Awareness of Nebraska Organizations to the 988
Lifeline
• Make 200 organizations statewide aware of 988 toolkits and promotional materials and educate them on where to access or order these materials.
Executive Summary of Breakout Groups
Prevention Strategies
Findings
• Need for state-mandated creation of formal prevention and postvention policies and procedures in school districts, as schools tend to prioritize required activities and braiding of funding sources to sustain efforts.
• Need to address barriers in rural Nebraska.
• Need to address barriers related to time and distance from training offerings to supplement effective prevention and postvention efforts.
• Need for centralized information of available prevention and postvention education, resources, and training options across the state.
Participants in the Prevention Strategies breakout sessions focused heavily on school-based pre- and postvention strategies. Participants identified a number of successes in this area. First, the Nebraska Department of Education was highlighted as a useful hub of prevention and postvention resources and trainings for school staff. The creation of Hope Squads in school districts and LOSS teams to serve communities across the state were also mentioned as successes.
Participants discussed a need for state-mandated creation of formal prevention and postvention policies and procedures in school districts, as schools tend to prioritize required activities. Another need participants saw was improving outreach to students, including increasing participation in Hope Squads, using social media to connect with students of different grade levels, having curricula that addresses mental health in schools, and providing more information about resources such as the 988 Helpline. Having more students discussing mental health also causes their parents to talk more about mental health, a virtuous cycle that increases buy-in and reduces stigma.
To increase sustainability, participants discussed the importance of creating braided funding sources for school-based suicide prevention and postvention. To sustain funding, participants noted the importance of collecting timely and accurate data to drive prevention efforts. Participants noted staff retention, time, and distance from trainings and resources in rural areas as barriers to effective prevention and postvention.
Outside of school-based prevention and postvention, participants discussed the importance of building community partnerships to address mental health. As an example, building community partnerships with local hospitals and behavioral health care providers helped to increase gun lockbox and trigger lock distribution. Partnerships between health care organizations are also important in providing wraparound care and warm handoffs when individuals are transferred between them. Getting multiple organizations, including schools, hospitals, and other providers, on the same page regarding suicide prevention was emphasized, as was the importance of considering individualized safety plans during, not after, an individual’s contact with these organizations. Participants again stressed the importance of education about available services and resources. Some suggested creating a resource guide for those
interested in what prevention and postvention trainings are available. Outreach to additional community partners, like faith partners, college campuses, and corporations, were also suggested.
Prevention Strategy Recommendations
• Suicide Prevention and Postvention Policies in Schools: Advocate for statewide suicide prevention and postvention policies in schools. Utilize and develop toolkits and resources designed for suicide postvention practices in schools.
• Expand Engagement in Schools: Continue practices and improve outreach to students and parents through engagement in Hope Squads, social media, and 988 resources. Improve student resiliency with evidence-based suicide prevention and mental health curriculum.
• Address Barriers to Training Access: Improve rural access to training offerings for rural communities through offering remote training options.
• Community Partnerships: Increase community partnerships, including schools, hospitals, and other providers, regarding suicide prevention and emphasizing the importance of individualized safety plans across organizations.
• Centralize Resource Information: Create a centralized system for listing and providing information on prevention and postvention resources, educational materials, and available training options.
Populations of Concern
Findings
• There is a need for culturally competent care and outreach strategies as various populations face stigma and have distrust in mental health service.
• Men and veterans, especially in rural communities, face high stigma and limited access to mental health resources.
• Schools are often a hub for mental health resources, particularly in rural communities.
• Older adults can have limited access to transportation to care and many are not routinely screened for suicide risk.
Participants in the Populations of Concern breakout sessions discussed groups who may need additional or improved outreach from suicide prevention and postvention organizations. Older adults were mentioned as a population of concern. These individuals are often isolated, in nursing homes with staff who lack training in prevention and postvention, part of a cohort unused to discussing mental health issues and may lack access to transportation. Older adults are not routinely screened for suicide risk at medical appointments, and many are on Medicare or Medicaid, which have low provider reimbursement rates, which makes accessing care more challenging. Other patients in medical facilities are an additional population of concern, and there is an existing need for educating staff on mental and behavioral health needs of this population.
Another population of concern is the youth population. Much like the discussion on prevention strategies, participants highlighted the importance of schools as often the only mental health resources available to youth, especially in rural areas with limited resources. Youth in foster care were described
as often slipping through the cracks and as feeling a reduced sense of belonging in their communities. Participants emphasized the importance of teaching resiliency and how to deal with social media and online harassment. Outreach strategies to youth should include social media and text messaging.
Men, particularly middle aged or elderly, were also brought up as a population of concern. Men in rural areas face higher levels of stigma and less access to mental health resources. Farmers and those in other independent occupations like skilled trades tend to find it difficult to ask for help. Participants suggested outreach strategies including using AM radio, coffee shops, menu advertising, peer outreach, and faith organizations.
Participants discussed how veterans have difficulty accessing mental health care, both because of red tape and a general lack of access, especially in rural areas. Staffing issues in the VA system were mentioned as an exacerbating factor. Participants suggested outreach strategies centered on building trust through staff and providers with military experience.
People experiencing homelessness were mentioned as a vulnerable population who lack places to go for mental health care. The need for continuing care can be difficult to address without stable housing. Incarceration often becomes the last resort for care, limiting individuals’ future options.
Working class individuals and first responders were both brought up as populations whose experiences place them at greater need for mental health services. Participants suggested increasing awareness of resources and reducing stigma for both groups. Reducing stigma was also emphasized as a way to reach religious individuals who may experience greater stigma from their peers.
The Native American population was mentioned as having a lack of trust in mental health providers and facing cultural stigma against seeking out mental health resources. Greater representation among mental and behavioral health providers and a more diverse workforce were suggested as strategies to improve outreach.
The LGBTQA+ community was described as having limited access to mental health resources that they feel will treat them without judgment. Family and community stigma are also factors preventing seeking access to care. Outreach strategies to this population include using social media and increasing trust by being consistent allies.
The participants in the populations of concern breakout groups additionally identified a number of strategies for improving suicide prevention and postvention. First, consistent funding for mental and behavioral health efforts and training and outreach resources is important. Participants identified the need to subsidize and/or reduce costs of mental health provider insurance and education, as well as increasing the number of people in the mental health workforce and increasing Medicare and Medicaid reimbursement for mental and behavioral health services. Increasing education and outreach in all workplaces was also mentioned.
Participants also referenced the need for mental and behavioral health training for health care personnel and law enforcement, both to provide support for staff who may suffer from burnout, and to reduce stigma and fear when staff interact with individuals with mental health needs. Standardized training regarding suicide was suggested, as was training on how to physically and verbally handle individuals in crisis.
Populations of Concern Recommendations
• Culturally Competent Care: Encourage and seek out culturally competent based trainings for providers and community members.
• Targeted Outreach: Utilize targeted messages and campaigns for populations of concerns. Find representation and use strategies tailored to specific populations.
Systems Thinking
Findings
• Men are underrepresented in suicide prevention efforts, despite experiencing suicide rates 2-3 times higher than women. This lack of representation poses a significant barrier to engaging male audiences and reducing stigma associated with seeking help.
• Barriers to care in rural communities remain significant, with challenges including persistent staff shortages, high turnover rates, and limited transportation options to access services in these areas.
• Provider burnout and staff shortages and turnover were a significant barrier in implementing care and suicide prevention efforts statewide.
• Insufficient mental health literacy among community members highlights the need for upstream community education on mental health and suicide prevention.
In the third set of breakout groups, participants were asked to discuss what they would like to see to improve suicide prevention and postvention in Nebraska, regardless of feasibility. These ‘magic wand’ sessions allowed participants to think beyond the current scope of prevention efforts in the state.
Participants stated that they would like to have more men involved in prevention efforts, especially since suicide rates are higher among men. Campaign messaging targeted at multiple ages, occupational groups, and race/ethnicity groups were discussed as ways to reduce stigma.
Participants also highlighted multiple means to increase access to mental and behavioral health services, including revitalizing the group therapy model, reducing wait times to see counselors, and utilizing community behavioral health centers. Promoting self-care among clinicians and mental health workers was discussed as a way to prevent staffing turnover and shortages. Telehealth was mentioned as an important strategy to increase access in rural areas. Community-based services including peer support groups and coalitional prevention networks were also highlighted as ways to bolster prevention. To develop these networks, participants emphasized the need to fund ongoing capacity development, which may involve moving away from a fee-for-service funding model. Reducing the cost of care for families was important to many participants. Improving data and tracking were also discussed as goals to pursue. Connecting different data systems and making data available to the public were mentioned, as were improving reporting of suicide and drug overdose deaths.
In general, participants were interested in ways to increase mental and behavioral health education in the wider community. Strategies to do so included working with the media and promoting responsible reporting around mental health issues, integrating mental health education into schools, providing mental health first aid trainings to community members, increasing community education around lethal means restriction, and working with the knowledge that mental and behavioral health issues affect
every member of the community. Equipping every member of the community with the skills to recognize signs of suicide risk was a primary goal of many participants.
Systems Recommendations
• Address Provider Turnover: Mitigate provider turnover and staff burn out through investment in provider and staff well-being and self-care trainings.
• Increase Male Engagement: Increase participation from men in suicide prevention efforts through peer-led initiatives and outreach programs.
• Community Education: Integrate evidence-based mental health and suicide prevention training across healthcare settings, schools, first responder agencies, and community organizations. Enhance targeted efforts to raise awareness about mental health stigma and promote lethal means safety.
APPENDIX ONE: FULL BREAKOUT SUMMARIES
Prevention Strategies
Successes
Participants in the Prevention Strategies breakout sessions discussed the successes and opportunities achieved through suicide prevention and postvention efforts, particularly in the school sector. Notable achievements include the successful integration of prevention programs across various school levels, such as SCIP (School Community Intervention & Prevention Program) and Wraparound services. Additionally, Mental Health First Aid and QPR (Question, Persuade, Refer) trainings, tailored for both youth and college students, have been effectively implemented. The creation of Hope Squads in school districts and LOSS teams to serve communities across the state has also been highly successful. Furthermore, participants highlighted the Nebraska Department of Education as a valuable hub for prevention and postvention resources and training for school staff.
Participants noted that leveraging social media has proven to be an effective tool for outreach and awareness. Popular platforms are being used successfully to disseminate information about suicide prevention to younger demographics.
Although significant work and resources are still needed, the focus on lethal means safety, including medication disposal and CALM (Counseling on Access to Lethal Means) training, represents a major development in schools.
The creation and implementation of the 988 Lifeline has been a tremendous success for the state of Nebraska. However, all participants agreed that increased efforts are necessary to spread awareness and provide more information about this lifeline to all residents, especially students.
Challenges/Barriers
Significant progress has been made on prevention strategies, yet participants discussed several challenges that have hindered the effectiveness of these efforts. A major barrier identified is resource constraints, including limited funding, time, and staff. Additionally, participants noted a need for statemandated creation of formal prevention and postvention policies and procedures in school districts, as schools tend to prioritize required activities.
Stigma continues to be a significant challenge, exacerbated by misconceptions and cultural taboos that affect how mental health is perceived and addressed. Moreover, the lack of resources in other languages can severely impact the effectiveness of mental health services for non-English speaking populations. This gap, combined with different cultural approaches to mental health, complicates efforts to effectively engage and support diverse communities.
Addressing these challenges requires targeted efforts to improve resource allocation, improve cultural competence, reduce stigma, and develop clear policies and infrastructure to support mental health initiatives.
Sustainability
In terms of sustainability, participants highlighted the importance of timely and accurate data, especially in rural communities. Improved data collection systems are needed not only for understanding needs but also for tracking outcomes and measuring the impact of the strategies over time.
Participants emphasized the importance of improving the dissemination of comprehensive information about key resources, such as the 988 Lifeline, due to ongoing confusion about what it is and how it works. Additionally, educational initiatives targeting youth could foster a cyclical process where increased student knowledge leads to greater parental awareness and involvement. To achieve this, participants agreed that addressing the shortage of staff and the lack of time faced by school personnel is crucial. Expanding the workforce in both the school and mental health sectors is essential for the sustainability of prevention efforts.
Participants discussed the gaps in education related to lethal means safety, highlighting the need for greater awareness among parents about safely securing medications and other potentially harmful items. Partnering with local hospitals and behavioral health providers to implement strategies such as distributing lock boxes and establishing policies to ensure their availability is crucial to reduce risks.
Training for primary care providers is another vital component of sustainability. Beyond conducting mental health screenings, providers need skills and confidence to handle the “then what” aspect, knowing how to proceed with care and support after a screening identifies a potential issue.
Increasing grant funding is also essential to sustaining suicide prevention efforts. More financial resources can support a variety of initiatives, from expanding peer support programs to developing resources in multiple languages and enhancing systems for tracking outcomes.
Populations of Concern
During this breakout room session, participants shared their perspectives on some specific populations that are most vulnerable to suicide, as well as the reasons behind this vulnerability. In addition, they discussed the efforts made to reach these populations, successes achieved, and the ongoing needs to continue supporting these individuals.
Identified Populations
The rural community was one of the populations most mentioned by the participants in this session. There is significant stigma surrounding mental health issues in this community, especially among farmers. These individuals are used to handling everything on their own, silently bearing the weight of their work and family responsibilities. Moreover, their remote locations from urban centers severely limit access to resources, information, and support.
The LGBTQA+ community is also highly vulnerable to suicide. The discrimination and stigma faced by this group create in them a lack of belonging and safety, placing them in a particularly at-risk situation. Unfortunately, support resources for this community remain limited, data is insufficient, and the lack of representation among behavioral health professionals is another significant barrier for its members.
Participants also voiced concern about the Native American population. Cultural differences, language barriers, and systemic issues, among other factors, have created obstacles to accessing available mental health resources. There is also an urgent need for better data collection to analyze and understand this community's needs more comprehensively.
Veterans are another population of concern, facing several critical challenges in accessing mental health care. One significant issue is the bureaucratic red tape that complicates their ability to receive care, especially in rural areas where VA services are sparse or non-existent.
The growing population of elderly individuals often faces isolation and has unique needs that are not fully addressed by current care systems, making them a particularly vulnerable community. For instance, elderly individuals may experience significant loneliness and fear of losing their independence, which can exacerbate feelings of hopelessness. They also struggle with inadequate routine screenings and financial barriers due to low Medicare and Medicaid reimbursement, which complicates access to care.
Participants also discussed college students as another population of concern. Many students experience isolation and a deep need for belonging, which can be compounded by anxiety, perfectionism, and sleep deprivation. Additionally, the normalization of stress within academic environments, combined with poor coping mechanisms, further strains their mental well-being.
First responders and healthcare providers were also mentioned as a population of concern due to the burnout and lack of sleep they constantly faced as a result of staffing shortages at their workplaces.
There were many other vulnerable groups that participants identified as needing immediate assistance. Homeless individuals, for instance, are among the most vulnerable due to the lack of available mental health resources, places where they can receive care, and the simple fact of not having a stable home for ongoing treatment.
Although in very different contexts, the working class was also mentioned. This group continued to work during the COVID-19 pandemic, enduring the emotional strain of this global emergency, which has resulted in significant fatigue even years after the crisis has passed.
Finally, another population frequently discussed by participants is survivors and family members of those affected by suicide. The trauma, feelings of guilt and shame, coupled with stigma in the community, places this group in a state of extreme vulnerability to suicide.
Efforts
Participants also took some time to share recent efforts to address suicide among these vulnerable populations. They mentioned how the Kim Foundation's resource table at construction sites has led to meaningful group discussions about lethal means and strengthened important community relationships and partnerships.
Advocacy and support groups have played a crucial role in raising awareness. In rural communities, efforts such as organizing awareness walks and other local events have proven effective in engaging residents and spreading vital information about suicide prevention.
The introduction of Applied Suicide Intervention Skills Training (ASIST) in rural areas has facilitated more open discussions to address mental health and suicidal thoughts. Similarly, resiliency training provided to military personnel has been effective in building protective factors and enhancing mental health.
The expansion of telehealth services has significantly increased access to care, particularly in remote areas where mental health providers are scarce. In the same way, enhanced screening processes and resources available in schools and workplaces have contributed to better support and identification of at-risk individuals. In addition, the introduction of the 988 Lifeline hotline has further improved access to immediate support, providing a critical resource for those in crisis.
Areas of Need
The participants in these breakout groups also identified several needs for improving suicide prevention among populations of concerns. One major point highlighted was the importance of integrating basic suicide prevention education in school curricula, along with the implementation of surveys to better understand prevention needs within schools. Additionally, participants discussed the need of introducing QPR training to parents when students are in middle school and providing education on lethal means safety to better equip families to support their children.
Improved data accessibility was another necessity discussed by participants. There is a significant need for a centralized system where data can be shared, particularly data from the Department of Human Services that correlates suicide rates with different populations.
Participants emphasized the importance of leadership support and advocacy for mental health and suicide prevention efforts. They also mentioned the need for more resources dedicated to bullying and violence prevention as well as an increase in diversity and representation within the mental health workforce.
Overall, the focus group highlighted the necessity of a well-rounded approach that combines education, training, data management, community support, and financial investment to effectively address the needs of populations vulnerable to suicide.
Systems Thinking
Blue sky thinking on how to improve suicide prevention across systems in the state of Nebraska
In the third set of breakout groups, participants were asked to discuss an imaginative scenario where they could wave a magic wand to improve suicide prevention in the State of Nebraska. They shared their insights, ideas, and creative solutions for tackling critical and systemic issues.
A key emphasis was on the need to engage more men in prevention efforts, given the higher rates of suicide among men and their use of more lethal means. Participants suggested targeted campaigns, such as those during football games, to reduce stigma and promote mental health discussions among men.
A significant issue highlighted was the waiting times for counseling services that are affected by a shortage of mental health practitioners, especially in rural areas. Solutions proposed included expanding the availability of same-day and next-day counseling through Certified Community Behavioral Health
Clinics (CCBHCs) and integrating telehealth with primary care to ensure regular mental health screenings.
The group also emphasized the need to increase peer support, alongside growing the prevention network through county coalitions, schools, faith partners, and law enforcement training. They recommended revisiting funding models to sustain prevention and education efforts, suggesting a move away from the fee-for-service model that had previously reduced funding in these areas
Addressing basic needs was another critical aspect, recognizing that meeting clients' basic needs can significantly impact their mental health and participants proposed partnerships with community action programs to address these needs. They also highlighted the importance of expanding the workforce of bilingual mental health professionals.
Data systems and death reporting were discussed as areas needing improvement. Participants noted the challenge of underreported deaths by suicide and suggested training for better accuracy in death reporting. They also highlighted the importance of connected data systems to facilitate information sharing and improve outcomes.
The group discussed the importance of lethal means restriction, including educating gun shop employees and offering temporary gun storage solutions for those in crisis. They also suggested involving the faith community in stigma reduction efforts and increasing funding to expand Hope Squads in schools.
Collaboration across organizations was identified as crucial, particularly for clients transitioning in and out of care. The idea of creating a "one-stop shop" for mental health services was suggested, alongside addressing challenges such as staff turnover and capacity issues.
Furthermore, they called for increased support for clinicians, including free self-care training and peer support initiatives to combat burnout and compassion fatigue. Enhancing access to mental health care in schools, normalizing mental health conversations, and integrating mental health education into physical care was also mentioned.
Addressing rural challenges, participants noted the need for improved internet access and mobile network reliability to support telehealth, especially for children. They also emphasized the need for more providers and resources, particularly in rural areas, and suggested simplifying licensing transfers for clinicians moving from other states.
Finally, the group proposed a variety of strategies to enhance community prevention, including training for community members, coordinated and responsible media campaigns, and developing culturally competent materials. They advocated for consistent funding, better data systems, and additional resources, such as the potential use of AI to support mental health services statewide.
