The numbers are tragic, and staggering.  There were 1,120 suicides in Missouri last year, giving the state the eleventh-highest suicide rate in the nation. A majority were in the St. Louis and Kansas City metro areas, though rural suicide rates are actually higher than in urban areas. Sixteen percent of those 1,120 deaths were veteran suicides.  There were forty thousand calls to the National Suicide Prevention Lifeline and twenty-six thousand crisis text line conversations. Twenty-five percent of college students reported serious thoughts of suicide in the past year—a high percentage of them transgender or LGBQQ youth.  Those statistics come from the Missouri Institute of Mental Health (MIMH) at the University of Missouri–St. Louis, which in partnership with the Missouri Department of Mental Health has launched several projects aimed at addressing the crisis of suicide in the state.  For a decade the two organizations partnered on the Missouri Suicide Prevention Project (MSPP), funded by a federal grant from the Substance Abuse and Mental Health Services Administration that targeted youth-serving organizations and at-risk persons between the age of ten and twenty-four. The project sponsored gatekeeper training for as many as one hundred thousand people in Missouri including school staff, students, mental health providers, and first responders, among others.  “That’s a program where they’re training people, the general public, how to talk to somebody who is potentially suicidal,” says Dr. Elizabeth Sale, the evaluation director and a research associate professor at the MIMH.  The institute even created a free suicide prevention app that taught people to recognize warning signs and get help for people feeling suicidal and also funded depression screenings, support groups, and suicide prevention efforts on college campuses in addition to coordinating annual state conferences.  Just as grant money for the MSPP dried up and the program ended, there was a shift at the federal agency towards offering programs more directly involving people who had been considering suicide. That led to other programs at the MIMH like the Missouri Youth Suicide Prevention Program in Kansas City, which provides “immediate, in-person mental health follow-up care to suicidal youth identified in hospitals, schools, and the community.” “It was a shift to mental health providers going to the hospitals or schools and actually working to identify youth there to get them directly into services,” Elizabeth says. “Before it was more of a general population approach, more public health, and then it shifted into some continued gatekeeper training but a lot of us work in terms of direct services where people are suicidal.” That program has shown reductions in suicidal ideation and attempts, inpatient hospitalizations, and emergency room visits.  Elizabeth and the MIMH also provide evaluation services and technical assistance to the Department of Mental Health and its involvement since 2014 in the Zero Suicide initiative, a program more focused on adults who engage the state’s community behavioral health centers. Those centers reported a 32 percent decrease in suicide deaths among clients from 2015 to 2017.  “If you integrate all of the suicide prevention into physical and mental healthcare centers, hospitals, you get into the primary care that’s really the next step,” Elizabeth says. “We measure based on the attempted suicides and hospitalizations, ER visits, and ideation so that’s where we’re seeing the effects,” she says.  The MIMH has launched follow-up programs in only a few places, including Kansas City and St. Louis, due to a lack of funding.  “More funding across the board is really, really needed,” Elizabeth says.