Factors that increased the trend                                                                                                           

• Stigma (Provider Bias) and discrimination, not knowing how to respond, fear, judgment, or lack of understanding, fear of judgment
• Standards of care/resources:  access to services, lack of resources/services, unaware of services or how to obtain care/resources, unavailable care, lack of culturally available services, biased services, medical services are unavailable, don't know where to get help/unaware, unable to reach services/unavailable, awareness of services
• Sharing across systems and coordinated services  
• Alienation or isolation (rural and outlying areas)
• Mental Health untreated
• Not knowing how to respond/fear  
• Bullying
• Situational stress 
• Perception of political climate and harm related to the immigrant population
• Substance Abuse
• Untreated mental illness
• Language barriers (culturally competent services)

Factors that decreased the trend

• Outreach of and for mental health
• Community Engagement
• Medical Services at schools
• Improved training services
• Awareness events
• normalizing; normalizing the conversation and well-being
• providing access to resources
• Appropriate screening and follow-up
• Access and linkage to resources
• awareness events
• culturally appropriate services
• improve training services including front line providers - training about mental health/capacity building
• Provide additional Mental Health First Aid training
• Sharing data
• Establishing standards of care across sectors
• Strong faith community support and engagement

Who are partners that could help decrease the trend? 

• Suicide Prevention Advisory Board member, SCOE, Superintendent of schools office/council, Modesto City School, including SCSU, and MJC, CSU Stanislaus, Sylvan, Modesto, Stanislaus Union, Empire, Ceres, Oakdale, Riverbank, all school districts, Superintendent Council
• Central Valley Pride Center
• Center for Human Services
• NAMI
• American Foundation Suicide Prevention
• Other Advisory Board members, Suicide Prevention Advisory Board Membership
• Hospitals - Sutter Health, Kaiser, Golden Valley, Doctors Hospital
• Law Enforcement - Modesto Police Department (Crisis Intervention), Stanislaus Sherriff's Department, and Turlock Police Department, Ceres Police Department
• Coroner Office - Death Review Team
• Faith-Based Organizations - Clergy
• Family Resource Center
• Workforce Development Resources (EDD)
• Inviting and starting conversations with Partners
• Define resources for all participating agencies
• Raiz Promotores (13 sites serving hard to reach)
• Central Valley Hotline

Evidence-based practices

• Mental Health First Aid (adult and youth)
• Zero suicide framework for medical staff capacity building, Safe Talk, MH First Aid, Fresno/website
• Peer support
• Crisis team
• Community inclusion
• more mental health providers
• education training for providers
• myth buster, stigma prevention
• culturally appropriate stigma prevention

Promising practices

• Resource and referral
• Education doctors (physicians) and medical staff
• "S" Word Campaign Awareness
• Raiz Promotores
• Brief Intervention Counseling (5 regions, MHSA Funded, PEI facilitated)

Low-cost/No-cost

• Community presentations
• Awareness events like "Active Minds"
• Connection with the faith-based community (churches, clergy)
• social media and other low-cost media 

Off the wall ideas

• Engagement and Outreach Community van