For nearly two centuries, the United States has struggled to build humane and effective responses to mental health crises. Today, the consequences of fragmented systems remain clear: individuals experiencing mental illness or suicidality are too often routed through emergency rooms, homelessness, or the criminal justice system when community-based care would better meet their needs.
Efforts to reform behavioral health crisis response date back to the mid-19th century. In 1843, social reformer Dorothea Dix began advocating for the creation of psychiatric hospitals to remove individuals with mental illness from county jails and provide more humane treatment. Her work helped drive the development of large state psychiatric hospitals, which by the mid-20th century housed hundreds of thousands of individuals.
By the 1960s, concerns about institutional conditions led to a new push toward community-based care. President John F. Kennedy’s Community Mental Health Act of 1963 envisioned a national network of community mental health centers designed to replace institutional care with locally accessible services; however, the broader system of community-based services was never fully funded. As large institutions closed without sufficient community infrastructure to replace them, many individuals with serious mental illness once again became entangled in the criminal justice system.
Law enforcement leaders and county governments have worked to address the growing role of jails as de facto mental health facilities. Initiatives such as the Stepping Up campaign and the One Mind Campaign have encouraged communities and law enforcement agencies to adopt policies and training designed to improve responses to people experiencing behavioral health crises. These efforts have highlighted a critical truth: public safety systems cannot solve this challenge without a robust behavioral health crisis response system.
Recent federal legislation has significantly improved the nation’s behavioral health crisis response infrastructure. The National Suicide Hotline Improvement Act of 2018 and the National Suicide Hotline Designation Act of 2020 established 988 as the national number for suicide and behavioral health crises. While these actions created a critical access point for people in crisis, states must now ensure that comprehensive crisis response systems are in place to support those who seek help.
Someone to Contact: 988 Lifeline and Other Behavioral Health Lines
Someone to Respond: Mobile Crisis and Outreach Services
A Safe Place for Help: Emergency and Crisis Stabilization Services
Together, these elements form the foundation of a modern behavioral health crisis response system—one that saves lives, reduces strain on emergency services, prevents the criminalization of health conditions, and connects individuals to meaningful treatment and recovery supports.
Governors and state legislators play a critical role in ensuring that behavioral health crises are met with care rather than criminalization. While some states, including Virginia, Tennessee, and Washington, have made significant investments in coordinated crisis systems, many others have yet to align their policies and funding with SAMHSA’s 2025 National Guidelines.
Recommended Policy Actions:
The Crisis Collaborative, a body representing crisis call takers, mobile crisis teams, co-responders, Crisis Intervention Team (CIT)–trained law enforcement officers, police social workers, crisis residential providers, and crisis system researchers, urges state leaders to implement these national guidelines and take the following policy actions:
Pass legislation establishing a regulatory framework for crisis services and ensuring adequate reimbursement structures within the state Medicaid plan and through general fund appropriations to support crisis call centers, mobile crisis teams, emergency behavioral health walk-in centers, crisis respite programs, and crisis residential services.
Ensure private insurers reimburse for all regulated and licensed crisis services without requiring pre-authorization, with particular attention to reimbursement for emergency behavioral health walk-in centers, crisis respite programs, and crisis residential services.
Amend the Emergency Medical Treatment and Labor Act (EMTALA) that governs ambulance transport and explicitly permits reimbursement for transport to emergency behavioral health walk-in centers so that law enforcement is not required to transport individuals to treatment.
Ensure that at least 90% of federal 988 funding allocated to state mental health authorities is designated to support operations of 988 call centers.
Establish in-person state training mandates and standards for law enforcement officers focused on de-escalation and understanding mental illness and suicidality.
Elevate the role of certified peer specialists and peer-run services as critical to a full continuum of crisis response through state law and policy.
Provide adequate funding and insurance reimbursement for alternatives to incarceration, including Assertive Community Treatment (ACT), which provides intensive community-based support for individuals with acute mental illness without requiring institutionalization.
Require clinical engagement to explore treatment options prior to execution of an involuntary commitment, recognizing that far fewer individuals benefit from forced treatment than are currently subjected to statutory mandates.
Support various models of mobile response, allowing communities to provide the service in a manner that best serves the members of their community.
Fund Housing First models to address and elevate the chronic challenges of homelessness.
Each one of the desired outcomes articulated above will require significant multidisciplinary advocacy efforts. Implementing a coordinated behavioral health crisis response system requires decisive leadership at the state level.
With thoughtful legislation, strategic funding, and collaboration across behavioral health and public safety sectors, states can build crisis response systems that save lives, support recovery, and reduce the criminalization and stigmatization of mental illness.
Recognizing that every community is unique, our mission is to advance state-specific legislative and regulatory changes that include the funds necessary for communities to deliver timely, compassionate, and impactful crisis responses.
Our Shared Values: Every person experiencing a suicidal or mental health crisis deserves a rapid response that is empathetic and access to quality care that best meets their individualized needs.
Our Approach
The Crisis Collaborative comprises multiple entities whose members include peer specialists, law enforcement officers, fire/EMS professionals, corrections professionals, mental health clinicians, police social workers, mobile crisis responders, crisis call takers, and suicidologists. We strongly support SAMHSA’s Vision of “Someone to Call, Someone to Respond, and Somewhere to Go.” However, we do not believe service or responses should be narrowly defined. It is critical that options are elevated and supported in state policy. Options like peer-run respite centers and alternative mobile responders working in partnership with a CIT Officer on a co-responder team.
We recognize that an impactful and compassionate crisis response will look different in Wyoming or Maine than in Philadelphia or Chicago. Fundamentally, we do not believe that any one organization speaks for the crisis continuum, just as there is not one approach to prevent suicide or the criminalization of mental illness.
Together, we work to advance crisis system transformation that respects the resources, cultures, and diverse identities of people living in each state, territory, and First Nation.
Crisis Collaborative Representatives:
Jenna Mehnert Baker, DPA, MSW, SHRM-CP Chief Executive Officer American Association of Suicidology jenna@suicidology.org
Anthony Merklinger Community Engagement Manager American Association of Suicidology anthony@suicidology.org
The American Association of Suicidology (AAS) has been approved as a continuing education (CE) provider by the Association of Social Work Boards (ASWB), expanding access to accredited, evidence‑informed suicide prevention training for social workers nationwide.
This approval applies across AAS’s training portfolio, strengthening clinical, supervisory, and systems‑level competencies through the following courses:
Crisis Supervisor Series (Parts I–IV): A four‑part leadership development track for professionals transitioning into supervisory roles in crisis settings, covering core competencies from foundational leadership to administrative and human resources responsibilities.
Recognizing and Responding to Suicide Risk: Essential Skills for Clinicians: A 14-hour advanced training focused on suicide risk assessment and intervention using evidence-based approaches.
Recognizing and Responding to Suicide Risk: Colleges and Universities: A specialized adaptation of the core clinical training for higher education settings.
Suicide Prevention: Considerations for Special Populations: A training focused on culturally responsive strategies for supporting marginalized and underserved communities.
Social workers can earn ASWB‑approved CEs at this year’s AAS26 Annual Conference (May 17–22, St. Louis) through Recognizing and Responding to Suicide Risk: Essentials for Clinicians® (2‑Day Course) and Suicide Prevention: Considerations for Special Populations®.
The American Association of Suicidology (AAS) has been approved as a U.S. Department of Defense (DoD) prevention provider for the Integrated Primary Prevention Workforce Credentialing Program for Prevention Personnel (IPPW D-CPPP) Continuing Professional Education (CPE) credits, expanding access to accredited suicide prevention training for the DoD and affiliated workforce.
Several sessions at the 59th Annual Conference have already received DoD approval, with additional workshops under review.
Approved Workshops:
(PERD) Applying Thirty Years of Suicide Prevention Research to Community-Based Solutions
(PERD & PHB) Breaking Down the Silos: Community-based Development of a Substance Abuse and Suicide Prevention Community Helper Training
(PERD) Determining the Relative Importance of Risk Factors for Suicide Attempts in a Sample of Residential Patients with Opioid Use Disorder Using Dominance Analysis
(PERD) From First Response to Prevention: Coordinated Crisis Care in Rural & Frontier Communities
(PERD) Growing Together: Enhancing Community Engagement Strategies for Veteran Suicide Prevention
(LEAD) Quiet Battles: What Military Leaders Carry—and How Moral Health Heals
(PHB) Restoring Mission, Restoring Lives: A Community-Centered Strategy for Veteran Suicide Prevention
(PHB) Rewiring Hope: How Neuroscience Explains Mindfulness as a Lifeline in Suicide Prevention
(PHB) What We Learned After the Unthinkable: Postvention, Healing, and Suicide Prevention
Approved (Category Pending as of April 28, 2026):
15 Years of Zero Suicide: Looking Back — Looking Forward
A Cultural Infusion Implementation Framework for Sites Using the Zero Suicide Approach, With Lessons from New York State
Factors Impacting Officer Suicide and Effective Interventions
First Responders / Service Members Paper Session 1
Beyond PTSD: How Lived Experience, Moral Injury, and System Leadership Shape Suicide Prevention
Mission Connect Vermont: A Governor’s Challenge Initiative to Prevent Suicide Among Service Members, Veterans, and Their Families
QPR Gatekeeper Training to Support Law Enforcement
Silent Aftershocks: Mental Health and Suicide Prevention for First Responders and National Guard During Natural Disasters
Pending Second Review:
988 Update — Progress and Future Directions
Clinical Innovation for Suicide Prevention in Systems of Care: What’s Working for Whom
Contemporary Treatment for Complicated Grief through Meaning Making in Suicide Loss Survivors
From AI Tools to Clinical Impact: Achieving (and Measuring) Results in Responsible Ways
From Training to Practice: Using Structured Mentorship to Strengthen Crisis Counselor Confidence and Suicide Prevention Care
Integrating Narrative Identity in Suicidology: A Clinical Exploration of Story, Identity, and Suicide
These offerings are part of the AAS26 Annual Conference, taking place May 17–22 in St. Louis. This year’s theme, Moving Forward Together: Advancing Suicide Prevention through Science and Lived Experience, highlights the integration of research, practice, and lived experience.
The American Association of Suicidology is deeply saddened by the tragic domestic violence and murder-suicide involving former Virginia Lt. Gov. Justin Fairfax and his wife, Cerina Fairfax. We extend our condolences to their children, family, and all those affected by this devastating loss.
This episode reflects the dangerous intersection of domestic violence and suicide. Research consistently shows that access to a firearm significantly increases the likelihood that domestic violence incidents will result in death, particularly for women, and increases the lethality of suicide attempts.
While the specific circumstances of this case are still being understood, we know that reducing access to lethal means during periods of crisis and conflict can save lives.
We urge continued attention to evidence-based strategies that address both interpersonal violence and suicide risk, and we reaffirm our commitment to prevention efforts that protect individuals, families, and communities.
If you or someone you know is experiencing domestic violence or emotional distress, confidential support is available:
The National Domestic Violence Hotline: 1-800-799-7233 or thehotline.org
The 988 Suicide & Crisis Lifeline: Call or text 988, or chat via 988lifeline.org
The American Association of Suicidology (AAS) is alarmed by the U.S. Supreme Court’s decision yesterday to treat conversion therapy as constitutionally protected free speech. We respect the legal process; however, this ruling has serious implications for youth safety nationwide, particularly in states that rely on these protections to prevent harmful practices.
Let us be clear: conversion therapy is harmful. Major medical and mental health organizations have long established that conversion therapy is dangerous and unsupported by scientific evidence. It carries no therapeutic value and exposes minors to interactions that increase psychological distress.
The American Association of Suicidology filed a joint amicus brief in this case with The Trevor Project and American Foundation for Suicide Prevention, documenting decades of research showing that conversion therapy places minors at significant risk of serious psychological harm and increased suicidality.
AAS remains committed to advocating for policies that protect all young people from preventable harm.
We urge policymakers in every state to ensure that youth, especially those who face stigma or discrimination, have access to care that supports their safety and well‑being. When protective environments are weakened, the risk of suicide increases, and the systems designed to safeguard young people are dismantled.
Additional Resources on Conversion Therapy and LGBTQ+ Youth Mental Health
For those seeking more information, the following resources provide research and data on the impacts of conversion therapy and the mental health experiences of LGBTQ+ youth:
Nonprofit organizations serving local communities are invited to join a national conversation on strengthening suicide prevention efforts.
The American Association of Suicidology invites nonprofit suicide prevention organizations that provide prevention, intervention, and postvention services at the county, regional, or state level to join us for a national conversation on Friday, April 3, 2026, at 12:00 PM (EST). This session will explore how AAS can strengthen its support for organizations and professionals advancing suicide prevention efforts.
AAS remains committed to ensuring that suicidology research effectively informs suicide prevention efforts in the field. One way we do this is through targeted training and certification programs designed to meet community needs, including our Psychological Autopsy Training–now offered again as a formal certification.
We recognize that meaningful change often happens locally and that your work directly influences policies and practices at the county and state levels. We hope you will join this conversation to share your perspectives.
The American Association of Suicidology (AAS), the nation’s largest and oldest suicide prevention membership organization, strongly opposes the U.S. Department of Education’s proposal to remove nursing, social work, and counseling degrees from the list of federally recognized professional degrees. These professions are the bedrock of suicide prevention and behavioral health services. At a time of severe workforce shortages and rising suicide rates, increasing barriers to entry for these fields would significantly weaken states’ ability to meet the mental health needs of their communities.
AAS is committed to ensuring that the science of suicidology directly informs cultural, population‑specific prevention. For nearly six decades, we have advanced suicide prevention through professional training, credentialing, research dissemination, and the publication of a leading peer‑reviewed journal. We pioneered the accreditation of crisis call centers and developed the psychological autopsy model now used nationwide to better understand the complex factors contributing to suicide deaths.
Through this longstanding work, AAS has a clear understanding that effective suicide prevention relies on a highly trained clinical and community workforce. Professionals with degrees in nursing, social work, and counseling deliver the majority of suicide‑related care, and their work is grounded in rigorous, standardized educational competencies that ensure consistent, high‑quality practice across the country. Our nation’s suicide prevention system cannot function without these core professions.
The U.S. Department of Veterans Affairs, as one example, is the nation’s largest employer of social workers, with more than 20,000 across 1,300 facilities, and it trains approximately 1,500 social work interns each year. These professionals provide suicide prevention services, crisis intervention, clinical care, and case management that address housing instability, food insecurity, and other critical factors that elevate suicide risk.
Removing nursing, social work, and counseling degrees from federal professional degree recognition would increase the financial burden on students entering already underpaid fields, reduce enrollment in essential professions, deepen existing workforce shortages, and undermine state and national suicide prevention efforts.
As a national organization dedicated to preventing suicide, we urge federal and state leaders to reject this proposal from the U.S. Department of Education. The United States needs more, not fewer, highly trained professionals committed to protecting the health and well‑being of our communities.
“Suicide” is not the same as “Physician Aid in Dying”
Executive Summary
The American Association of Suicidology recognizes that the practice of physician aid in dying, also called physician assisted suicide, Death with Dignity, and medical aid in dying, is distinct from the behavior that has been traditionally and ordinarily described as “suicide,” the tragic event our organization works so hard to prevent. Although there may be overlap between the two categories, legal physician assisted deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.
Beginning in the mid-1980s with legal tolerance in the Netherlands and in 1997 with the effective date of the Oregon Death with Dignity Act, physician aid in dying has become legal by statute or court decision in a number of US states and international jurisdictions. Although legal requirements vary from one jurisdiction to another, all require well-documented choice by the patient and a serious medical reason for such a choice, either terminal illness, intolerable or unbearable and irremediable suffering, or both. In the US, self-administration of the lethal medication is seen as a safeguard against abuse and is required by law; in most European jurisdictions and in Canada, physician administration of the lethal medication is also permitted and is the predominant practice. In all jurisdictions, the physician is protected by law provided the legal requirements and/or practice guidelines are followed, including reporting the case to the designated authorities. Physician aid in dying (PAD) is called by a number of different names, including “physician assisted suicide” (PAS), “physician assisted dying” (PAD), “Death with Dignity” (DwD), “medical aid in dying” (MAiD) and more, all of which are used in the medical and sociological literature.
The American Association of Suicidology (AAS) recognizes that the practice of physician aid in dying is distinct from the behavior that has been traditionally and ordinarily described as “suicide,” the tragic event our organization works so hard to prevent. This recognition does not assume that there cannot be “overlap” cases, but only that the two practices can in principle be conceptually distinguished and that the professional obligations of those involved in suicide prevention may differ.
Points of difference between suicide and physician aid in dying include the following:
Under US law, the patient requesting aid in dying must be diagnosed by two independent physicians as terminally ill, defined as death expected within six months. In suicide, a life that could have continued indefinitely is cut short. PAD is not a matter of life or death; it is a matter of a foreseeable death occurring a little sooner but in an easier way, in accord with the patient’s wishes and values, vs. death later in a potentially more painful and protracted manner.
In PAD, the person with a terminal illness does not necessarily want to die; he or she typically wants desperately to live but cannot do so; the disease will take its course. Suicide, by contrast, even when marked by ambivalence, typically stems from seemingly unrelenting psychological pain and despair; the person cannot enjoy life or see that things may change in the future.
In PAD, the individual who is already facing death often experiences intensified emotional bonds with loved ones and a sense of deepened meaning as life is coming to an end; in suicide, by contrast, the individual typically suffers from a sense of isolation, loneliness, and loss of meaning.
The term “suicide” may seem to imply “self-destruction,” and the act may be cast that way in some cultural and religious traditions. Ending one’s life with the assistance of a physician and with the understanding of one’s family is often viewed more as “self-preservation” than “self-destruction,” acting to die while one still retains a sense of self and personal dignity, before sedation for pain or the disease itself takes away the possibility of meaningful interaction with those around one.
Suicide in the conventional sense often involves physical self-violence, as in gunshot wounding, self-hanging, jumping, self-cutting, self-drowning, and the ingestion of substances or compounds that may cause painful death. PAD in contrast is intended to provide the physically easiest, least violent, least disfiguring, most peaceful form of death an already dying person could face.
While suicide in the conventional sense may involve sustained suicidal thinking and prior planning, during periods of acute stress suicide decisions-to-act are sometimes reached shortly before the fatal act. All US statutes legalizing PAD include safeguards against impulsivity: all require two oral requests, separated by a 15-day waiting period, plus a written request signed in the presence of two witnesses.
In suicide, the person often “sees no way out” of their desperate situation. Under the PAD statutes in the US, the physician is required to inform the patient of all feasible alternatives for relieving their situation, including comfort care, palliative care, hospice care, and pain control.
Suicide in the ordinary, traditional sense is much more common among those with mental illness, where it may be a complex byproduct influenced by anhedonia, impaired thinking, cognitive distortion and constriction, impaired problem-solving, anxiety, perseveration, agitation, personality disorders, and/or helplessness and hopelessness. Under the PAD statutes, in contrast, mental illness that would affect the rationality of decision-making is screened out, and where, as in some European jurisdictions, PAD is legal in cases of unbearable suffering in intractable mental illness, heightened scrutiny is required. Evidence of depression and other mental illness is, by statute in the US, subject to evaluation by a psychiatrist or psychologist and, if it is determined to be influencing the decision, the patient is not qualified under the law.
The conventionally suicidal person may be unable to assess his or her situation clearly or objectively; the person considering PAD is typically able to balance the choice of an earlier death against the loss of control and increased medicalization they may experience as they enter the end-stages of a terminal illness. According to studies from the Netherlands, the patient who dies with physician assistance forgoes on average about 3.3 weeks of life.
The legal status and consequences of the two acts are different. In the United States, the statutes in those states with “Death with Dignity” or “End of Life Options” laws assert that such a death “shall not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide under the law.” Deaths under these laws are not reported as suicide on death certificates, but as death from the underlying terminal condition.
Studies from Oregon and the Netherlands show that the impact of PAD on bereavement in family members tends to be less severe than in other deaths. In contrast, those bereaved by suicide deaths have higher rates of complicated grief and PTSD and may be at higher risk for suicide themselves.
Death by suicide is often associated with substantial social stigma, often a considerable burden for bereaved families or other persons involved, including, for example, treating physicians and psychotherapists. Where it is legal, PAD is typically well accepted within the community and society at large.
Research methods and findings that have frequently been used in the attempt to decrease the incidence of suicide as traditionally defined do not apply well to PAD. For example, risk factors considered significant in some strategies of suicide prevention, like childhood trauma, addiction, recent divorce, access to firearms, or other factors that may contribute to emotional pain or capability of suicide, do not typically apply to those choosing PAD. Attention to “warning signs” is not relevant; PAD deaths that meet the legal criteria are typically planned in consultation with a physician and within a family that knows what to expect.
PAD deaths do not incur the sometimes substantial forensic and other costs that suicides do, especially suicides by school-age children and adolescents. They do not invite dilemmas of publicity. In PAD, after-the-fact efforts to determine the reasons for the death are not necessary; the process is well-documented by the physician.
Unlike most cases of suicide, the person who has requested and receives aid in dying does not typically die alone and in despair, but, most frequently, where they wish, at home, with the comfort of his or her family.
The possibility of overlap between suicide and physician aid in dying:
The finding that physician aid in dying is not suicide does not mean that some requests for PAD by people with terminal illnesses could not be closer to conventional suicides in character. All US statutes require that if either of the two independent physicians suspect that that depression or other mental illness is playing a distorting role in the decision, a psychological or psychiatric consult is to be called; mental health professionals also involved in suicide prevention may be asked to provide such evaluations. Where factors compromising the capacity for decision-making are found, such cases are to be screened out from access to PAD. In these cases, traditional suicide prevention services and treatment for depression may well play a role.
Nor does the fact that suicide and PAD are not the same indicate that some cases identified as suicides may not be deaths that have a great deal in common with PAD, especially those in which poor health is a precipitating factor. Although such cases are typically labeled ‘suicide’ if the person initiated the causal process leading to death, medical conditions associated with suicide risk in potentially terminal illness—including (among the best studied) cancer, cardiovascular disease, COPD, Huntington’s, HIV/AIDS, multiple sclerosis, ALS, Parkinson’s, renal disease, and Alzheimer’s—may arise from the motivation to avoid a protracted, debilitating, and potentially painful bad death. While many forms of end-of-life care may be helpful, including palliative and hospice care, a patient’s choice of PAD that satisfies legal criteria is not an appropriate target for “suicide” prevention.
Conclusion
In general, suicide and physician aid in dying are conceptually, medically, and legally different phenomena, with an undetermined amount of overlap between these two categories. The American Association of Suicidology is dedicated to preventing suicide, but this has no bearing on the reflective, anticipated death a physician may legally help a dying patient facilitate, whether called physician-assisted suicide, Death with Dignity, physician assisted dying, or medical aid in dying. In fact, we believe that the term “physician-assisted suicide” in itself constitutes a critical reason why these distinct death categories are so often conflated and should be deleted from use. Such deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.
