It’s not easy to talk about suicide, even though it touches so many of us. Many have lost someone, worried about someone, or lived through a crisis ourselves. And for people who work in suicide prevention, the information that could show where help is needed most can be scattered across systems that are rarely looked at all together.
To build a fuller picture of who dies by suicide in King County and where there are opportunities to help, we recently published three new suicide data dashboards. These dashboards link about a dozen sources of data including death records, health care, jails, crisis services and homelessness services. When viewed together, these data tell an important story about when and where systems can work to better prevent suicide.
We sat down with our epidemiologists who built the dashboards, and with colleagues who work in crisis care and injury prevention, to learn what viewing suicide data in this layered way can reveal about gaps in prevention and opportunities to provide support to those who need it.
A more complete picture
“Suicide is complex. It’s not like strep throat, where there’s a single cause and a test and an easy treatment,” said Spencer Hensley, an epidemiologist with Public Health – Seattle & King County. “Our perspective was that it would be useful to bring together as much data as we could, to get as complete a picture as we could.”
The project, called NO HARMS (New Opportunities for Health and Resilience Measures for Suicide Prevention), was funded by a grant from the Centers for Disease Control and Prevention (CDC) and was aimed at identifying the value of linked data for suicide prevention. “What makes this unique,” said Dr. Alastair Matheson, Public Health’s Data Modernization Director, “is the breadth of different kinds of systems, types of data and services that are now all in one place. They’ve been looked at one by one, but never as a whole. This idea was that it would give more insights, more information, and better knowledge that we could use to change programs and practice.”
Critical windows of intervention
Across systems, the data show a critical opportunity to intervene. Suicide risk is highest during the first 30 days after a person visits an emergency department, leaves a hospital or jail, or uses crisis or homelessness services. After that, risk goes down, though it generally stays above the King County average.
“Historically, when people leave these different care settings, there was not immediate availability for outpatient care,” said Dr. Matt Goldman, a psychiatrist and the Crisis System Medical Director at the King County Department of Community and Human Services (DCHS).
The Department of Community and Health Services is using the Crisis Care Centers Levy to help close this gap, Goldman explained, by developing a robust post-crisis follow-up program for their Crisis Care Centers. Crisis Care Centers are places anyone can walk into 24/7 to get urgent care for a wide range of mental health, drug or alcohol use challenges, regardless of insurance. This first Crisis Care Center opened in Kirkland in 2024 and plans are underway to open additional centers in Seattle, South and East King County, plus one for youth.
“The program will provide up to 90 days of weekly service with mental health clinicians and peer support specialists to help people at risk of a repeat crisis such as suicide with engagement and navigation of care,” Goldman said. “But that’s only for folks who are leaving Crisis Care Centers. There are plenty of other settings, as this data shows, that need this.”
Beyond crisis systems, positive transitions like leaving the hospital after getting healthy or being released from prison are also suicide risks that sometimes go unrecognized, according to Karyn Brownson, Public Health’s intentional injury lead and manager of Lock it Up, a safe storage program for gun owners. “Many people in the community would look at someone in one of those situations and say, ‘oh, good, now they’re going to be okay, because this crisis care or this legal intervention ended. But destabilization [good or bad] is a contributor to risk.” For Brownson, this points to the need for more collaboration between formal services and programs like hers – which provides secure firearm storage education and access to storage devices to our community.
On a hopeful note, recent data also shows that efforts to connect clients of King County’s behavioral health services to outpatient care after a hospitalization are working and setting a national standard for follow-up care that’s helping prevent repeat crisis.
Insights from the field reflected in the data
For Ariana Donaville, a program manager with the Regional Office of Gun Violence Prevention, the high rate of suicide amongst veterans rang true to her experience on the ground supporting communities impacted by gun violence. “We host a large gun lockbox giveaway at the Veteran’s Day Parade in Auburn. Most of the people who pick up lockboxes are veterans and families of veterans. We hear a lot from them about experiences with suicide – whether they’ve lost someone or experienced suicidal thoughts themselves.”
Donaville sees the data as an opportunity to approach funders with creative ideas about how to support two other demographics highly impacted by suicide at once – older adults (75+) and young adults transitioning into adulthood (18-24). Older adults suicide death rates were 18.5 per 100,000 people and young adults suicide death rates were 16.3 per 100,000 people, compared to the County-wide rate of 11.5. “I’ve seen successful programing across the country where they are linking grandparents to young people to share life advice and connection.” Data about suicide demographics is often siloed and so the solutions are siloed too. “We work in a lot of Black and brown communities across King County, and suicide is not talked about enough. I’m looking forward to diving deeper into the demographics, looking at the specific locations, and seeing how those overlay with our service areas.”
Substance use and suicide
The data reveals substance use as another risk factor for suicide. People who have emergency department or primary care visits for substance use or mental health have an increased risk of suicide attempts and suicide death. Many people turn to drugs and alcohol to cope with disruptive life events and mental health issues, and substance use in turn can intensify negative thinking, impair judgement and lower self-control.
“It’s really complicated,” said Goldman. “There’s what’s happening underneath, in somebody’s daily life experience, that might lead them to a moment of crisis where they feel ambivalent about living, and that could be highly related to their substance use. But there’s also the fact that they’re having these ambivalent thoughts about living, which could potentially be intervened on with some additional supports.”
Substance use treatment programs can enhance screening and suicide prevention activities. “We’ve done a better job on this in recent years, but mental health services and substance use services are still too far apart,” said Brownson. These efforts are even more critical as more people have access to more lethal drugs like fentanyl which make overdose more likely to be fatal.
What’s next?
The CDC grant ends this month. “Right now, these dashboards are a point in time,” Matheson said. “It’s a lot of work to bring 12 different data sources together on a regular basis. Figuring out ways to do that efficiently will allow us to see what changes over time including whether new programs are making a difference.”
Hensley and Matheson are excited to share the findings with more partners in jails, opioid response and homelessness services, and learn from them about what they’re seeing, what they are already doing, and how this data can help support their work.
For Goldman, he’s excited to build on this work, noting the unique opportunity of the Crisis Care Centers Levy which is investing $1.2 billion over nine years into a crisis continuum of care at scale, including enhanced 24/7 crisis call center resources like 988, expanded mobile crisis team capacity, the crisis care centers themselves, and additional follow-up supports. “This is a real opportunity for evaluation…to try to get a more rigorous understanding of actual outcomes: can we move the needle on some of these metrics? We want a partner in that, and this data has laid an amazing foundation for being able to track and monitor a lot of what we are doing.”
We all have a role to play
Brownson has two messages she wants everyone to hear. The first is for anyone who is struggling: “Suicidal thoughts don’t have to turn into action,” she said. “You are not stuck with that decision, and there are ways to survive. And in fact, often people who have been chronically at risk of suicide have a lot of wisdom about how to survive and we need them in our conversations about solutions.”
The second is for the rest of us. “You don’t have to be an expert, or a clinician, or a system person, to help suicide happen less,” she said. “We all can create a fairer, more equitable world. We all can create connectedness with the people we know. That’s part of the system of prevention.”
One opportunity coming up is our next anonymous gun buyback event on October 17th in Burien. “This event, hosted in partnership with the King County Sheriff’s Office,” Donaville describes, “provides a safe and anonymous way for King County residents to dispose of unwanted firearms, which can help reduce the risk of them being used in a crisis or falling into the wrong hands.” Building on the success of their recent Suicide Prevention Month Gun Buyback event, where 221 firearms were collected in exchange for gift cards and 73 lock boxes were distributed, this event will be set up as a drive –thru, where participants remain in their vehicles. Mental health resources and firearm safe storage devices will be available to those turning in firearms in exchange for gift cards. “We all have a role to play in keeping our communities and our loved ones safe,” said Donaville.
Suicide prevention resources
- 988 is the Suicide and Crisis Lifeline, available 24 hours by call, text or online chat.
- Crisis counselors from 988 can also send mobile crisis response teams to support people in-person anywhere in King County, including youth and families
- Anyone can walk into King County’s first Crisis Care Center in Kirkland for urgent mental health or substance use care.
Other supports
- The Geriatric Regional Assessment Team (GRAT) at Sound Generations — mental health and substance use outreach for older adults.
- The American Foundation for Suicide Prevention – resources for those coping with suicide loss.
- The American Association of Suicidology – a comprehensive list of resources for people who have lost someone to suicide and a Survivors of Suicide (SOS) directory.
- SAMHSA – Resources for caring for a loved one who has been hospitalized after surviving a suicide attempt.
- American Foundation for Suicide Prevention – resources for loss survivors, including helping children understand a suicide loss.
- Crisis Connections – expert care for people who are struggling with loneliness, depression, substance abuse disorder, recover, and many other life challenges.
Originally published 9/30/26