Cover: Should California Continue to Invest in Applied Suicide Intervention Skills Training (ASIST)?

Should California Continue to Invest in Applied Suicide Intervention Skills Training (ASIST)?

ASIST Could Save Lives and Wages and Reduce Medical Costs

Published May 18, 2015

by J. Scott Ashwood, Brian Briscombe, Rajeev Ramchand, Libby May, M. Audrey Burnam

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Research Brief

Over 4,000 people die from suicide every year in California, and there are many more who attempt suicide. In fact, suicide is among the top five causes of death among 10- to 54-year-olds in the state. To save lives and reduce the adverse social and financial effects of suicide, the California Mental Health Services Authority (CalMHSA) has fostered a statewide suicide prevention initiative, which is part of the prevention and early intervention programs funded by the Mental Health Services Act (Proposition 63) of 2004. This initiative implemented multiple programs and tools to prevent suicide.

In 2011, RAND researchers were asked to assist CalMHSA in evaluating the effectiveness of its prevention and early intervention programs. One such program, Applied Suicide Intervention Skills Training (ASIST), instructs clergy, first responders, teachers, and others holding jobs in which they are likely to come in contact with people at risk for suicide how to recognize risk factors, intervene, and link those at risk with appropriate resources. The ASIST workshops held from 2011 to 2013 prepared participants to conduct future ASIST workshops, thereby building suicide prevention capacity in communities throughout the state. The research team conducted a cost-benefit analysis to estimate the value of CalMHSA's continued investment in this program.

The study found that Californians stand to benefit from continued investment in the ASIST program in multiple ways:

  • Just one year of CalMHSA's investment in the ASIST program is projected to prevent at least 3,600 suicide attempts and 140 deaths over the next 28 years. This represents a reduction of 0.13 percent in the number of suicide attempts and deaths in the state.
  • By averting these suicide attempts and deaths, individuals and families will gain $1,100 for each dollar invested in ASIST by CalMHSA. These benefits include savings in medical costs and increased lifetime earnings.
  • The state government will gain $50 for each dollar invested in ASIST through averted Medi-Cal health care costs and increased state income tax revenue.

This analysis of costs and benefits was designed to be comprehensible and informative, rather than exhaustive. Quantifying the relationship between CalMHSA's investment in ASIST and California's gain in labor productivity, tax revenues, and averted medical costs does not consider nonmonetary benefits of suicide prevention (e.g., reduced suffering) but can help California policymakers put their investments into perspective.


The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families, and communities. Prevention and Early Intervention programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop. 63). Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California's diverse communities.

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