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State firearm survey data can inform firearm injury prevention strategies—read recommendations for developing state firearm surveys and applying findings.

Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots JoAnne Deehr Suicides continue to be a critical public health issue — learn how states are leveraging policy to improve suicide prevention. Suicide remains a persistent public health challenge, affecting people of all ages, racial and ethnic groups, geographic regions, and income levels in the United States. Despite ongoing prevention efforts, more than 49,300 Americans died by suicide in 2023. National suicide rates steadily rose from 2003 until 2018 and have remained high since then, reflecting an enduring and widespread impact. While all communities are affected by suicide, certain demographics face higher risks. Disproportionately higher rates of suicide are seen among elderly Americans, Veterans, individuals with lower income, less education, and those living in rural areas. People in certain industries, such as mining, construction, and public safety, are also at elevated risk. At the same time, emerging technologies like chatbots powered by artificial intelligence (AI) have raised new considerations related to safety, oversight, and appropriate use in mental health settings, underscoring the need for thoughtful state approaches to suicide prevention. Policymakers are responding to these challenges in multiple ways, including establishing state suicide prevention infrastructure and regulating AI chatbot use in mental health. Suicide Prevention Infrastructure Legislation Suicide prevention efforts are most effective when states and territories have dedicated infrastructure — such as suicide prevention offices, coordinators, commissions, and fatality review processes — to support coordination, surveillance, and implementation of evidence-based strategies. These structures enable state and territorial health agencies to identify populations and communities at increased risk, align partners across public health, health care, and public safety, and pursue sustainable funding for suicide prevention and crisis system improvements. ASTHO’s Suicide Prevention Offices and Committees Legal Map highlights the varied policy approaches states have taken to establish this infrastructure and identifies which states had statutory suicide prevention structures in place as of January 1, 2025. During the 2025 legislative session, states considered at least 30 bills related to establishing suicide prevention offices, coordinators, advisory bodies, and suicide fatality reviews. Five of these bills were enacted, including Delaware’s HB 54 which establishes the state’s Office of Suicide Prevention. Delaware also enacted HB 87, expanding membership in the state’s Suicide Prevention Coalition to include someone who has experienced suicidal ideation or survived a suicide attempt and someone who has lost a loved one to suicide. Conversely, Oklahoma enacted SB 676, repealing the section of the state’s Suicide Prevention Act that established the Oklahoma Suicide Prevention Council, which was slated to sunset in 2020. The council was originally tasked with identifying issues and promoting strategies to prevent suicide, and providing technical assistance on best practices for identifying people at risk of suicide. The Department of Mental Health and Substance Abuse Services still serves as the leading agency for implementing the remainder of tasks outlined in the Act. Illinois and Texas enacted legislation establishing advisory bodies focused on suicide prevention among first responders. In Texas, HB 1593 creates a committee to study suicide prevention and peer support programs within fire departments and requires a report with recommendations by September 2026. In Illinois, HB 2551 reconstitutes the First Responders Suicide Prevention Task Force, and increases membership in the task force to include a member from an organization that provides mental health training and support to first responders and two members who represent organizations that advocate on behalf of public safety telecommunicators, such as 911 operators and dispatchers. The bill also charges the task force with developing a final report by December 2026. Both bodies are scheduled to sunset in January 2027. Currently, Wisconsin has several types of fatality review teams operating through voluntary efforts with no law formally establishing or governing these teams. Wisconsin is considering SB 192, which would formally establish processes for reviewing fatalities, including deaths by suicide. It would also direct the Department of Health Services to establish a fatality review program comprised of established local teams and authorize the department to establish state fatality review teams. AI Chatbots While states continue to strengthen suicide prevention infrastructure, policymakers are beginning to turn their attention to emerging mental health considerations related to AI. Since emerging in the 1950s, AI has evolved from rule-based systems to today's machine learning and natural language processing applications, powering everything from data analysis to interactive chatbots. Recent AI advances enable chatbots to simulate human conversation so convincingly that users may forget they are interacting with a machine. However, these systems lack genuine empathy and cannot substitute for professional mental health treatment. Their tendency to be excessively agreeable creates particular dangers for people experiencing suicidal ideation, leading some states to explore regulations governing AI chatbot use in mental health and suicide prevention contexts. At least 19 states considered legislation regulating the use of AI for mental health related reasons to promote user safety. At least five bills were enacted, including California SB 243, which requires chatbot platform operators to disclose that users are interacting with AI if confusion could occur, develop protocols to prevent and respond to suicidal ideation or self-harm, and report annually on safety measures to the state Office of Suicide Prevention. The California legislature also passed AB 1064, which the Governor subsequently vetoed due to concerns that its broad restrictions on AI companion chatbots for minors could limit access to potentially beneficial tools. Illinois and Nevada passed legislation that largely prohibits AI from providing behavioral health services. Illinois HB 1806 restricts the use of AI for therapy or psychotherapy unless delivered by a licensed professional who is required to inform the patient, or their legal representative, in writing and receive consent. The law also prohibits licensed professionals from allowing AI to make independent therapeutic decisions or interact directly with clients and allows the use of AI only for administrative or supplemental tasks under professional oversight. Nevada AB 406 similarly prohibits AI systems from providing or representing themselves as offering professional mental or behavioral health care, prohibits AI from performing the functions of a school counselor, psychologist, or social worker in public schools, and allows licensed professionals to use AI only for administrative or supportive purposes, with oversight to ensure accuracy and safety. New York and Utah passed laws requiring mental health chatbots to clearly disclose that they are not human. As part of their annual budget, New York S 3008 mandates that AI companion systems capable of simulating human-like interactions detect suicidal ideation or self-harm, provide crisis referrals, and regularly disclose that users are interacting with AI rather than a person. Utah HB 452 requires AI-driven mental health chatbots to provide clear disclosures and limits advertising and data practices. At the federal level, on December 11, 2025, the White House issued an executive order seeking to establish a national policy framework for artificial intelligence and create a “minimally burdensome” federal approach. The order also directs the Department of Justice to form an AI Litigation Task Force to identify and challenge state AI laws deemed in conflict with this federal policy, and the Department of Commerce to limit eligibility for certain federal funds for states that take a non-preferred approach. The scope and criteria of these federal actions, including their impact on state laws aimed at suicide prevention, have not been clearly defined. Advancing suicide prevention will require states and territories to take comprehensive approaches that address both systemic gaps within state infrastructure and emerging technologies. ASTHO will continue to monitor these policy developments and provide relevant updates. Reviewed by - Baker-White, Maffey article yes

How to Craft Evidence-Based Messaging for the Prevention of Adverse Childhood Experiences How to Craft Messaging for ACEs Prevention Learn how to craft effective, evidence-based messaging to prevent ACEs — with steps and examples to guide your work. Getting Started When it comes to developing strategic messages, public health professionals must first identify the problem they are working to solve. Often, we think about problems in big, broad terms — this can make it hard to know what specific action(s) to take to solve them, especially when working to address complex problems like adverse childhood experiences (ACEs). Consider a common public health challenge: lack of coordinated and aligned prevention efforts among like-minded organizations in a community. While everyone is working toward similar goals, limited time and resources mean this lack of coordination can reduce overall impact. Simply naming “lack of coordination of prevention” as the problem, however, isn’t very helpful — your colleagues may not know what you’re asking them to do differently. To move from a vague concern to an actionable solution, you must narrow the problem. To do this, you might explain that organizations aren’t consistently communicating about what prevention programs they offer or approaches they implement. Digging further, the issue becomes not just misalignment but the lack of a regular, structured process for sharing updates. That clarity leads to a concrete ask: “We’d like to set up a monthly call where we each share program updates so we can coordinate efforts and maximize impact.” This final framing is strong because it identifies a specific, practical solution and serves as a clear foundation for effective messaging, plus next steps. Once you identify the actions to solve the problem at hand, you’re ready to think about the overall strategy. This resource walks you through several easy steps to outline your approach. Your Turn 1 - Resource - How to Craft Messaging for ACEs Prevention Using a Simple, Successful Formula The formula for a successful message is simple and helps you get to the core of your message: Name the problem or issue to be addressed. Talk about why it matters. Tell people what should be done and who should do it. Bonus: Use data to drive your message home. Put it all together. Step 1: Name the Problem You need to clearly state your concern: what the problem is and how you see it affecting people — but keep it short. Resist the urge to say everything. Instead, focus on the aspect of the problem that your proposed solution will address. Establish a general understanding of the issue and its impacts as they relate to ACEs. Example Consider, under the umbrella of ACEs prevention, the topic of reducing the cost of child care. Let’s name the problem: The high costs of child care contribute to economic pressures and stress for caregivers, leaving children at risk of experiencing maltreatment. Your Turn 2 - Resource - How to Craft Messaging for ACEs Prevention Step 2: Explain Why It Matters Using shared values in your messaging to describe why you care can help you make the case for your solution and connect with your target audience. Remember, values statements should indicate why you — and, ideally, your target — should address the problem at hand. What happens if nothing is done? And why does that matter? Example With our example, in working to reduce the cost of child care, this explanation might be: We must take action to support families because their well-being (mental, financial, etc.) as well as their children’s well-being are at stake. Your Turn 3 - Resource - How to Craft Messaging for ACEs Prevention Step 3: Emphasize the Solution Drawing from your overall strategy, keep your focus on the solution or the change you want to see, and name the person, group, or entity that needs to implement this change. It’s best to answer with a specific, feasible solution that is usually an incremental step toward the larger goal or vision. And it’s especially important to name who needs to take action, so that they are aware of what is expected of them. Name the solution you want to see. Example Continuing with our example, a solution to reducing the cost of child care might be: Our state legislature is currently considering a bill to subsidize child care cost in our area. Subsidized child care for families can reduce caregiver stress and increase their ability to provide financially for their families and spend time with their developing children. Your Turn 4 - Resource - How to Craft Messaging for ACEs Prevention Step 4: Drive Your Message Home with Data “Social math” is the practice of translating statistics and other data so that they become interesting, meaningful, and understandable by most people— unlike infographics, which use visuals (e.g., charts and graphics) to present data. Consider social math that can help you make your case. Example In our ongoing example, the following data and social math can help relay importance and meaning: Estimates show the annual national average price of care for one child in 2019 being between $9,200 and $9,600. In other words, families spend on average about $800 every month for child care — similar to a second rent payment. Your Turn 5 - Resource - How to Craft Messaging for ACEs Prevention Step 5: Bring It All Together as One Cohesive Message You can think of the final message as an answer to the question, “How does reducing ACEs lead to healthier outcomes and thriving communities?” Example The final message for our example could be: One of the greatest costs to young families is child care, with the estimated annual national average price of care for one child in 2019 between $9,200 and $9,600. In other words, one family will spend on average about $800 every month for child care — similar to a second rent payment. And these costs increase for every additional child in the household. Child care subsidies can reduce caregiver stress and lower the risk of child maltreatment by minimizing persistent concerns about child care, providing a source of emergency child care when needed, and improving the economic lives of families. We can support children and families by reducing the financial burden of child care, opening up opportunities to remain employed and receive other community or medical support they need. Your Turn 6 - Resource - How to Craft Messaging for ACEs Prevention Additional Resources ASTHO Strategic Public Health Messaging Drives Change Public Health & Crisis Communications Resource Hub State/Territorial Policy Considerations for Preventing Adverse Childhood Experiences CDC Beyond the Headlines: Media Communications Training Berkeley Media Studies Group Worksheet: Message Development (PDF) Media Advocacy Worksheet: Overall Strategy Layers of Strategy (PDF) Using Social Math to Support your Policy Issue ACEs in the News: How Can Advocates Communicate More Effectively About Childhood Trauma? 5 Ways to Create Compelling Messages About Childhood Trauma Using Data Issue 24: Adverse Childhood Experiences in the News: Successes and Opportunities in Coverage of Childhood Trauma Frameworks Institute Impact Spotlight: Framing Child Wellbeing CA Surgeon General's Campaign Brings Attention to Toxic Stress and Adverse Childhood Experiences (ACEs) Changing the Narrative Together: Three Effective Strategies for Talking about Youth Mental Health Moving from Crisis Toward Opportunity: Framing Social Media and Youth Mental Health Toolkit The Impact of Strategic Framing on Early Childhood Advocacy Efforts in Colorado Framing Fundamentals: What is Framing? #FastFrames Series Reviewed by - Maffey article yes

Funding local subrecipients can complement public health agency efforts and expand community reach—learn to navigate each funding stage.

Learn how states are balancing access to new plant-based substances with public health frameworks in this blog.

Promoting Mental Well-Being is a Vital Part of Comprehensive Suicide Prevention Caitlin Langhorne Griffith, Ali Maffey Suicide prevention efforts aren't comprehensive without promoting mental well-being. Each year, there are nearly 50,000 deaths by suicide and an estimated 1.6 million suicide attempts in the United States. Those statistics don't account for the compounded grief and loss experienced by impacted families, workplaces, schools, and communities. In October 2023, ASTHO, CDC, the Center for Law and Social Policy, and Mental Health America launched the Public Health's Role in Mental Health Promotion and Suicide Prevention Framework (Framework), which underscores how public health can improve mental well-being and prevent suicide. Public health's role in mental health promotion and suicide prevention is rooted in understanding that mental and physical health are both essential to the overall health of every person. Mental health promotion is one aspect of suicide prevention. Both areas share some risk and protective factors in common, and they share similar prevention strategies. These strategies focus on improving mental health and preventing suicide for all people, in every community, in the settings where they live, learn, work, and play. The White House recently launched the 2024 National Strategy for Suicide Prevention (the National Strategy), a 10-year, comprehensive plan to prevent suicide and suicide attempts. The National Strategy calls on leaders to demonstrate the ability to "Care, Connect, and Collaborate" when implementing effective policies and services that span the prevention spectrum. The Framework and the National Strategy define clear roles and responsibilities for public health and partners to properly equip communities to define solutions based on input from those most impacted. Integrating Community-Based Prevention Community-based prevention efforts focus on changing the conditions that increase risk or protect people from experiencing mental health challenges or contemplating suicide. Mental health and suicide share some risk and protective factors, such as a person's economic condition, past experiences of trauma or adverse childhood experiences (ACEs), and how connected they feel to others and their community. Strategies from ASTHO's Framework align with many of those outlined in the National Strategy, such as promoting protective environments, strengthening skills and knowledge related to help-seeking, resilience, problem-solving, and coping, and reducing stigma through community education. Additionally, ASTHO and the National Strategy recommend strengthening economic supports by creating stable housing, increasing access to affordable childcare, and increasing paid leave for caregivers. Improving the environment where people live is also crucial; public health can provide critical insight into land use decisions (e.g., creating green spaces and offering transportation alternatives). Lastly, ASTHO and the National Strategy both recommend a community-based prevention system that reduces access to lethal means to prevent suicide by firearm. Each of these components helps promote the mental health and well-being of all people to reduce their risk for suicide. Increasing Access to Quality Data High-quality data is imperative for developing robust mental health promotion and suicide prevention programs by monitoring relevant outcomes and the risk and protective factors associated with these outcomes. To support this effort, ASTHO, in coordination with CDC, developed the Suicide Indicator Explorer (Explorer). This interactive, visual tool helps health agencies identify potential measures for suicide prevention programs. The Explorer can spot suicide burden, patterns of risk and protective factors for suicide, data-driven prevention strategies that align with CDC's Suicide Prevention Resource for Action, data for evaluating programs, and disproportionately affected populations. Similarly, incorporating lived experience and community member input will increase overall quality data, resulting in better policies, programs, and community connections. Embedding Health Equity Approaches Integrating health equity throughout public health programming, funding, and policies related to suicide prevention and mental health promotion is critical. The Framework emphasizes the importance of public health, addressing social and institutional equities through policy and practice, which includes—but is not limited to—involving people with lived experience and communities most impacted in decision-making and implementing culturally responsive and linguistically relevant programs. Additionally, public health plays a pivotal role in ensuring that all communities have access to health care and healing systems, including Western medicine, spiritual, and cultural care with providers who look and speak like the communities they serve. Although anyone can experience suicide risk, certain populations are disproportionately affected (e.g., youth and young adults, people who identify as LGBTQ+, veterans, people with disabilities, people with mental health conditions, and people with ACEs). By tailoring interventions to fit the needs of those disproportionately affected populations, public health can remain grounded in health equity and ensure that mental health and well-being are at the center of each person's health. Moving Forward: Multi-Sector Partnerships Public health plays a clear role in helping to maintain strong partnerships, ensuring lived experience voices are at the forefront, and promoting safe and supportive communities. For instance, the Puerto Rico Department of Health coordinated across all 78 municipalities to train their communities on how to reduce suicide-related stigma. By creating training materials for various community partners, first responders, and those most affected by the risk of suicide, Puerto Rico reached their entire island without overextending their team. At the same time, the Vermont Department of Health partnered with agencies like their state’s Department of Mental Health and hospital system to include suicide prevention in emergency departments and improve screening, reduce access to lethal means, and increase follow-up care. These examples help demonstrate the importance of engaging a variety of partners. By implementing these strategies, public health can help prevent the risk of suicide before it occurs and mitigate the immediate and long-term harms of suicidal behavior. A public health approach to mental health promotion and suicide prevention includes addressing the multiple factors that influence these conditions as well as engaging multiple sectors, such as community-based organizations, health care systems, businesses, and schools. Each sector has a part to play in promoting mental health and preventing suicides, and public health is well-positioned to support all communities by creating a sense of well-being and helping them thrive. website yes