When Alaska overtook Nevada in 2000 in claiming the unenviable distinction of having the nation's highest suicide rate, the legislature created a 15-member task force charged with crafting a statewide plan to reduce the number of people who kill themselves.
Two years later, efforts to complete the plan have stalled. The coordinator of the task force resigned last May, and budget cuts left the position unfilled since.
A similar situation applies in the 22 other states lacking suicide prevention programs because of budget woes and an overall lack of funding for mental health services, state officials and prevention advocates said.
The states are Alabama, Arkansas, California, Connecticut, Delaware, Idaho, Illinois, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Nevada, New Hampshire, New Jersey, New Mexico, New York, South Carolina, Texas, Vermont, West Virginia, and Utah.
"Most of the states that don't have (suicide prevention) plans are poised and ready to go but they can't really implement them without getting at least a little money and resources," Davis C. Hayden, a suicide researcher and psychology professor at Western Washington University, said.
Suicide is the fifth leading cause of death among Alaskans, with 22 deaths per 100,000 people. Alaska natives experience suicide at a much higher rate of 42 deaths per 100,000, four times the national average of 10.7.
Susan Soule, who represents the state's Alcohol and Drug Abuse agency on the task force, said isolated rural communities have the highest rates of suicide, depression and substance abuse, but are the most underserved when it comes to mental health.
A draft of Alaska's suicide prevention plan, which focuses on raising public awareness and training educators and health workers in rural areas in intervention methods, has nearly been completed, Soule said.
But without a coordinator to oversee the 15-member volunteer council, their efforts have ground to a halt, she said.
"We haven't made any progress at the state level (since May), but grassroots activity is continuing," Soule said.
States in the Rocky Mountain West have long had high suicide rates, but there is no clear explanation why, experts said. Of those states, only Montana, Wyoming, Colorado and Arizona have adopted statewide prevention plans.
A grassroots-based Idaho effort to get the legislature to adopt a suicide prevention plan has been embraced by some state officials and dignitaries, including Idaho First Lady Patricia Kempthorne, but has failed to gain political traction.
"The legislature is very nervous about funding any new programs at a time when they are making extensive cuts in every state agency," said Peter Wolheim, who helped found Idaho's chapter of the Suicide Prevention Action Network.
Nationally, suicide is the 11th ranking cause of death and 50 percent more common than homicide, but has only recently gained the attention of lawmakers as a national problem, Hayden said.
In 1999, Surgeon General David Satcher launched an initiative that created the National Strategy for Suicide Prevention (NSSP) and called on states to use the national strategy as a framework for statewide plans.
Since then, the NSSP reports that 27 states have adopted suicide prevention plans based on the national strategy, which includes 11 goals and 68 recommendations intended to prevent suicides and attempts, as well as reduce the harmful after-effects they have on survivors.
But of those states, Heydan has identified only 17 (Colorado, Kansas, Louisiana, Maine, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Virginia, Washington and Wisconsin) that have a fulltime suicide prevention coordinator to implement the plans.
"The state coordinator is extremely important and it doesn't take a lot of money, a couple hundred thousand dollars a year to at least have a director or someone that can field questions and direct agencies to take action," Heydan said.