of the Maryland Department of Juvenile Justice, Education, and the Office of Chief Medical Examiners, as well. Various subcommittees then focus on particular levels of intervention, such as media education, the Maryland youth crisis hotline, and gun control efforts.

Maryland represents the first state to institute a statewide, toll-free youth crisis telephone hotline. Six centers comprise the hotline network, with several of them offering walk-in counseling, emergency shelter, and community education. Trained local crisis intervention counselors staff the hotline, and, in addition to making general mental health referrals, counselors make appointments at local mental health centers for those adolescents willing to disclose their identity. In the 10 years since its inception, Maryland has seen a 47 percent increase in calls to the hotline, with the modal age group increasing from 12–17 to 18–24 (Westray, 2001b).

A significant aspect of Maryland’s youth suicide prevention plan involves funds for schools to develop prevention programs. Every district chooses a particular focus: some have implemented general mental health curriculum, others have established school gatekeeper training and crisis response teams, and others employ peer helper programs, suicide awareness education, and mental health referral systems. If properly evaluated, such program diversity could perhaps give insight into which approaches most effectively reduce youth suicide.

The Maryland youth suicide prevention plan, in contrast to Finland’s program, for example, targets reduction of access to means by working to change policy regarding gun use and by educating the public on the relationship between handguns and suicide. The program also initiated an AIDS hotline in English and Spanish to reach traditionally underserved populations at risk for suicide. The Maryland model also includes educating the media on appropriate reporting practices concerning suicide, and uses public service announcements to influence community awareness of youth suicide and available services. Finally, the program collaborates with the University of Maryland to obtain research expertise for evaluation of program elements and for data surveillance.

Air Force Suicide Prevention Strategy

In response to an increased awareness of suicide as the second leading cause of death among active duty United States Air Force personnel (CDC, 1999), the Air Force formed a committee of civilian and military multidisciplinary experts to design a service-wide comprehensive suicide prevention strategy in 1996–1997. Drawing from the experiences of previous models, the Air Force prevention approach, dubbed “LINK,” emphasizes the social and community aspects of suicide alongside individual,



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