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Introduction

This proceedings presents a summary of what occurred at the Workshop on Best Practices for Implementation and Evaluation of a Non-Clinical Community-Based Suicide Prevention Grants Program, a hybrid workshop¹ hosted on April 29, 2025, by the National Academies of Sciences, Engineering, and Medicine’s (National Academies) Board on Behavioral, Cognitive, and Sensory Sciences (see Box 1-1 for the Statement of Task and Appendix A for the workshop agenda). The workshop was sponsored by the U.S. Department of Veterans Affairs (VA), and the National Academies appointed a workshop planning committee to organize and convene the workshop (see Appendix B for biographical sketches). This proceedings was prepared by the workshop rapporteur; the views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies.

WORKSHOP GOALS AND INTRODUCTORY PERSPECTIVES

Workshop presentations and discussions were structured to address the following topics as they pertain to non-clinical, community-based suicide prevention grants programs:

• Program development and oversight,
• Grantee-level implementation and performance metrics,
• Program evaluation, and
• Communicating program results.

In keeping with the Statement of Task (Box 1-1), the overall focus of the workshop was on non-clinical community-based programs intended to mitigate the impacts of social determinants of health on suicide risk. As discussed in the proceedings for an earlier workshop convened for the VA, social determinants of health include socioeconomic factors, social supports, health behaviors, exposure to violence, and characteristics of the physical environments in which individuals live and work (National Academies, 2022). Across workshop discussions, speakers often used the term “upstream risk factors”; while this is not precisely synonymous with social determinants of health, it does reflect many of the components of social determinants of health. In addition, a few workshop speakers touched on clinical interventions due to the importance of referring individuals experiencing acute suicidality to appropriate clinical care.

Daniel J. Weiss (National Academies) kicked off the workshop by placing it in the context of earlier convenings sponsored by the VA Office of Suicide Prevention that were overseen by the Board on Behavioral, Cognitive, and Sensory Sciences pointing participants to the resulting publications: Community Interventions to Prevent Veteran Suicide: Proceedings of a Virtual Symposium (National Academies, 2022) and Identifying and Managing Veteran Suicide Risk: Proceedings of a Workshop (National Academies, 2023). Weiss remarked on the importance of the board’s efforts in support of the Office of Suicide Prevention and the people who have served our country. Carl A. Castro (Col., U.S. Army-ret; Suzanne Dworak-Peck School of Social Work, University of Southern California; chair, workshop planning committee) echoed Weiss’s emphasis on the importance of the topic for both the active duty and veteran communities.

To frame the day’s discussions, Matthew Miller (VA Office of Suicide Prevention) offered an overview of veteran suicide trends and the core principles guiding the VA’s Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (Fox SPGP). He began by highlighting several encouraging indicators of progress in reducing veteran suicide, citing the most recent available data from 2022. That year’s suicide count was lower than 12 of the previous 14 years. Over 20 years, the suicide rate among veterans has risen more slowly than that of the non-veteran U.S. adult population. In 2022, the suicide rate for male veterans increased by 1.6 percent, compared to a 1.8 percent increase among non-veteran adult males; for non-veteran adult females the suicide rate increased by 5 percent, while the rate for female veterans decreased by 24 percent.

Miller also pointed to notable progress across subpopulations within the veteran community. Among veterans diagnosed with mental health conditions—who typically face elevated suicide risk—there have been reductions in suicide rates over time. For example, across 20 years, the suicide rate decreased by more than 30 percent for veterans diagnosed with a mood disorder and receiving care through the Veterans Health Administration. Similar reductions were observed among veterans diagnosed with post-traumatic stress disorder. For veterans with anxiety disorders, and substance use disorders, there has been a 20 percent decrease in the suicide rate over this period.

Miller described how the Fox SPGP, launched in 2022, embodies three foundational principles that guide the VA’s suicide prevention efforts:

1. Suicide is preventable; it is not inevitable. Interventions at the individual, community, and population levels can effectively reduce suicide risk and save lives.
2. Suicide prevention requires a public health approach. While high-quality clinical care—including emergency services and integrated

2. primary and mental health care—is essential, it is not sufficient on its own. Many risk and protective factors for suicide exist outside of the clinical setting. Addressing these factors through a public health framework is essential, and this is the core focus of the Fox SPGP.
3. Everyone has a role to play. Veteran suicide prevention requires contributions from many stakeholders outside of the VA. The Fox SPGP supports this by investing in community-based approaches and augmenting existing local resources that serve veterans. The goal is to equip, support, and expand the work being done in communities to prevent veteran suicide.

Miller reported positive developments from the first three years of the Fox SPGP. A congressionally mandated report after the program’s first year offered useful early insights into program start-up, reach, and operational dynamics, though it was limited in its ability to assess outcomes. A more recent third-party evaluation described encouraging indicators of progress in key areas, including program scope, participant outreach, and linkage to care. It also highlighted the program’s success in connecting veterans with both VA and community-based services—particularly emergency mental health resources.

Miller emphasized the VA’s commitment to ongoing improvement, learning, and collaboration. He described the workshop as a valuable opportunity to engage with the broader suicide prevention and mental health community—to gain insights, solicit feedback, and identify ways to strengthen both the Fox SPGP and broader VA efforts.

Looking ahead, Miller expressed optimism about the continuation of the Fox SPGP, citing sustained momentum, promising early results, and congressional support. He also noted the VA’s broader interest in contributing to the field of suicide prevention beyond its immediate mission. In addition to saving veteran lives, the VA sees its role as advancing knowledge that benefits suicide prevention efforts across the U.S. adult population more broadly.

ORGANIZATION OF THIS PROCEEDINGS

The organization of this proceedings reflects the structure of the workshop, with each chapter corresponding to a major session. Chapter 2 summarizes presentations on examples of non-clinical community-based suicide prevention programs, which were featured early in the workshop to establish context for the sessions that followed. Chapter 3 addresses two interrelated topics—considerations for program development and oversight, and grantee-level implementation and performance metrics—which were