01. Tier 1A: Highest-Impact, Lowest-Effort (1-9)
001
Means restriction: pesticide bans (WHO best-buy)
Modelled lives protected / yr (unverified)
50,000 to 150,000
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$125
Regulatory bans on highly hazardous pesticides in countries with high rural suicide rates (China, India, South Korea, Sri Lanka). 30-50% reduction in method-specific suicide documented in Sri Lanka after paraquat ban; estimated 150k lives/year globally at scale. Cost = regulatory + enforcement.
Source: Mann 2005 systematic review; WHO 2019 best-buy
002
Means restriction: firearm permit-to-purchase (PTP) laws
Modelled lives protected / yr (unverified)
8,000 to 25,000
Scenario annual cost
$20.0M to $60.0M
Scenario cost / life protected
$2K
Restore or expand permit-to-purchase handgun laws. CT PTP law associated with 15.4% drop in firearm suicides (synthetic control, 1981-2012). ERPO extreme-risk protection orders: 1 suicide averted per ~10-11 firearm seizures. Cost = legal infrastructure.
Source: Crifasi 2015 (PMC4566551); Kivisto Phalen; Studdert 2020
003
Means restriction: bridge barriers and jumping deterrents
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$10.0M to $80.0M
Scenario cost / life protected
$50K
Physical barriers on hotspot bridges (Golden Gate, Bloor Viaduct). Bloor Viaduct barrier cut suicides 80% at that site. Replicable at known hotspot sites. Cost = construction; very high DALY/$.
Source: Mann 2005 systematic review; multiple site studies
004
Means restriction: blister-pack analgesics (paracetamol)
Modelled lives protected / yr (unverified)
1,500 to 5,000
Scenario annual cost
$1.0M to $5.0M
Scenario cost / life protected
$923
Limit pack sizes of paracetamol and other lethal OTC analgesics. UK 1998 legislation cut paracetamol overdose deaths by 50% in 4 years. Cheap, fast. Cost = packaging reform.
Source: Mann 2005; UK legislation 1998
005
Safety Planning Intervention (SPI+) at ED discharge
Modelled lives protected / yr (unverified)
6,000 to 15,000
Scenario annual cost
$10.0M to $40.0M
Scenario cost / life protected
$2K
Brief structured safety plan + structured phone follow-up (2+ calls). SPI+ cohort: 45% fewer suicidal behaviors over 6 months (OR 0.56), 2x outpatient mental health visits. Adoptable in any ED. Cost = clinician time, training.
Source: Stanley & Brown 2018 JAMA Psychiatry
006
988 / 3-digit crisis line expansion (US 988, UK Samaritans, Lifeline AU)
Modelled lives protected / yr (unverified)
3,000 to 10,000
Scenario annual cost
$50.0M to $200.0M
Scenario cost / life protected
$19K
Three-digit memorable number + 24/7 trained crisis counselor coverage. ASIST-trained counselors make callers significantly less suicidal (OR 1.74). 988 launched July 2022 in US. Cost = telephony + staffing.
Source: Gould 2007-2013 silent monitoring; Hoffman 2022
007
Youth Aware of Mental Health (YAM) school program (ages 13-17)
Modelled lives protected / yr (unverified)
2,000 to 8,000
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$2K
Universal school-based mental-health awareness + role-play. SEYLE RCT: OR 0.45 for incident suicide attempts at 12mo vs control. Effective for adolescents, age 15-29 highest-burden group. Cost = curriculum + facilitators.
Source: Wasserman 2015 SEYLE RCT (Lancet); meta-analysis 2022
008
Lethal means counseling (brief in-clinic firearm safety conversation)
Modelled lives protected / yr (unverified)
2,000 to 8,000
Scenario annual cost
$1.0M to $5.0M
Scenario cost / life protected
$600
5-minute physician-led conversation with at-risk patient and family about temporarily removing firearms. ~1 in 10-11 ERPO seizures averts a suicide. Cost = clinician training.
Source: Mann 2005; Harvard Means Matter; Runyan 2024
009
AI chatbot CBT for depression (Therabot / Woebot / Wysa / Earkick)
Modelled lives protected / yr (unverified)
5,000 to 30,000
Scenario annual cost
$1.0M to $10.0M
Scenario cost / life protected
$314
Fine-tuned generative-AI therapy chatbot for MDD/GAD/CHR-FED. Therabot RCT: d=0.845-0.903 for MDD vs WLC. CBT-chatbot meta-analysis 29 trials, g=-0.55 depression. 24/7, scalable, zero waitlist. Cost = inference + dev.
Source: NEJM AI Therabot RCT 2025 (d=0.84 MDD); JMIR CBT chatbots 2026 (g=-0.55)
02. Tier 1B: Foundational Psychotherapy and Clinical Care (10-18)
010
Dialectical Behavior Therapy (DBT) for borderline personality disorder
Modelled lives protected / yr (unverified)
1,500 to 5,000
Scenario annual cost
$20.0M to $80.0M
Scenario cost / life protected
$15K
DBT vs CTBE: half the suicide attempts (HR 2.66, NNT 4.24). 5-RCT meta: Hedges g=-0.62 for parasuicidal acts. Cost = 1yr weekly individual + group skills.
Source: Linehan 2006 JAMA Psychiatry; Panos 2014 meta-analysis
011
Caring Contacts post-crisis text/email outreach
Modelled lives protected / yr (unverified)
1,500 to 5,000
Scenario annual cost
$500K to $3.0M
Scenario cost / life protected
$538
Personalized non-demanding text/email messages at 3 days, weekly, monthly, birthdays. Complements SPI+. Cost = messaging platform + content.
Source: SPARC trial 2024 (NCT04893447); VA Compassionate Contacts
012
Brief Intervention and Contact (BIC) post-suicide-attempt
Modelled lives protected / yr (unverified)
2,000 to 6,000
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$3K
9-session telephone/home-visit outreach after suicide attempt. WHO/BIRPI trial in 5 nations cut deaths ~50% in intervention group. Cost = outreach workers.
Source: Fleischmann 2008 WHO multicentre; multiple LMIC studies
013
Gatekeeper training (QPR, ASIST, safeTALK) for adults in contact with youth
Modelled lives protected / yr (unverified)
1,500 to 6,000
Scenario annual cost
$5.0M to $25.0M
Scenario cost / life protected
$4K
Train teachers, coaches, clergy, primary care to recognize warning signs and refer. ASIST counselors reduce caller suicidal state (OR 1.74). QPR modest effect vs YAM. Cost = training programs.
Source: Wasserman 2015 (QPR); Gould ASIST studies
014
Universal screening for suicide risk in primary care + ED
Modelled lives protected / yr (unverified)
3,000 to 8,000
Scenario annual cost
$2.0M to $10.0M
Scenario cost / life protected
$1K
PHQ-9 + item 9 / C-SSRS / ASQ at every primary care & ED visit. ~3-5x identification vs unaided. Cost = screening instrument + workflow.
Source: Botchway 2022; Dunlap 2019; US Joint Commission NPSG 15
015
AI mood/passive-sensing monitoring for high-risk patients (smartphone + wearables)
Modelled lives protected / yr (unverified)
2,000 to 8,000
Scenario annual cost
$2.0M to $10.0M
Scenario cost / life protected
$1K
Smartphone keyboard, sleep, location, voice signals flag depression/suicidality 2-4 weeks pre-crisis. Sends alert to clinician. Continuous, low-friction. Cost = app + integration.
Source: NEJM Catalyst 2024; multiple 2024-2026 pilot RCTs
016
Universal anti-suicide public messaging campaigns (Papageno effect)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$2.0M to $10.0M
Scenario cost / life protected
$2K
Responsible media + pro-help-seeking ads in mass media. Reduces suicide rates in the messaging catchment. Cost = media buy + content.
Source: Niederkrotenthaler 2010-2024 meta-analyses
017
Cognitive Behavioral Therapy (CBT) for suicide attempters
Modelled lives protected / yr (unverified)
2,000 to 7,000
Scenario annual cost
$30.0M to $120.0M
Scenario cost / life protected
$17K
Manualized CBT for adults after attempt: ~50% reduction in re-attempt. CBT is gold standard psychotherapy. Cost = therapist time.
Source: Rudd 2015; Brown 2005; multiple meta-analyses
018
Lithium maintenance in bipolar disorder
Modelled lives protected / yr (unverified)
800 to 3,000
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$9K
Lithium vs placebo: OR 0.13 suicide reduction, OR 0.38 all-cause mortality. ~50% reduction in suicide attempts in bipolar. Cost = drug + monitoring.
Source: Cipriani 2013 BMJ meta-analysis (OR 0.13); Tondo 2001; Cipriani 2024 update
03. Tier 1C: Acute Pharmacologic and Crisis Care (19-27)
019
Esketamine (Spravato) for treatment-resistant depression / acute suicidal ideation
Modelled lives protected / yr (unverified)
600 to 2,500
Scenario annual cost
$30.0M to $120.0M
Scenario cost / life protected
$48K
84mg intranasal esketamine twice weekly under REMS. Rapid MADRS reduction 24h (LSMD -3.9). FDA approved for TRD + active SI. Cost = drug + monitored clinic time.
Source: ASPIRE I/II Phase 3 (Canuso 2018; Fu 2020)
020
Collaborative Assessment and Management of Suicidality (CAMS)
Modelled lives protected / yr (unverified)
1,500 to 6,000
Scenario annual cost
$15.0M to $60.0M
Scenario cost / life protected
$10K
CAMS-focused outpatient care vs TAU cuts suicidal ideation, increases treatment retention. Adaptable to telehealth. Cost = clinician training.
Source: Jobes 2012-2024; multiple comparative trials
021
Cognitive Therapy for Suicide Prevention (CT-SP) / Wenzel
Modelled lives protected / yr (unverified)
1,500 to 5,000
Scenario annual cost
$20.0M to $80.0M
Scenario cost / life protected
$15K
Brief cognitive therapy for suicide prevention, 10 sessions over 6 months. Cuts re-attempt ~50%. Cost = training.
Source: Wenzel 2009-2018 RCTs
022
Primary-care collaborative care for depression (IMPACT, PATH)
Modelled lives protected / yr (unverified)
3,000 to 10,000
Scenario annual cost
$50.0M to $200.0M
Scenario cost / life protected
$19K
Stepped collaborative care with care manager + psychiatrist consult. Reduces suicidal ideation in late-life depression by ~50%. Cost = staff + telepsychiatry.
Source: IMPACT trial Unutzer 2002 JAMA; multiple meta-analyses
023
Esketamine + SSRI/SNRI augmentation for severe depression
Modelled lives protected / yr (unverified)
500 to 1,500
Scenario annual cost
$20.0M to $80.0M
Scenario cost / life protected
$50K
Combined treatment resistant depression pathway. Cost = drug + REMS clinic.
Source: Popova 2019; Daly 2019; ASPIRE II
024
NHS-style Improving Access to Psychological Therapies (IAPT) at scale
Modelled lives protected / yr (unverified)
5,000 to 20,000
Scenario annual cost
$200.0M to $800.0M
Scenario cost / life protected
$40K
UK stepped-care model: self-help, guided self-help, low-intensity CBT, high-intensity CBT. ~50% recovery rate, 65% reliable improvement. Cost = training pipeline + IAPT digital.
Source: IAPT evaluation 2008-2024 (Clark)
025
988 SMS/text crisis service expansion
Modelled lives protected / yr (unverified)
1,000 to 4,000
Scenario annual cost
$5.0M to $25.0M
Scenario cost / life protected
$6K
Text-based crisis line for digital-native population. Adolescent preferred channel. Cost = text platform + counselors.
Source: Crisis Text Line data; Gould 2018
026
AI companion for 24/7 non-crisis loneliness support (Woebot, Earkick, Replika)
Modelled lives protected / yr (unverified)
2,000 to 10,000
Scenario annual cost
$500K to $5.0M
Scenario cost / life protected
$458
General emotional-support AI app, offloads demand from crisis services. Daily engagement reduces PHQ-9 by 30-40%. Cost = inference + app dev.
Source: Fitzpatrick 2017; NEJM AI 2025; multiple 2025 RCTs
027
Crisis residential stabilization (sub-acute, 24h supervised, <14 days)
Modelled lives protected / yr (unverified)
500 to 2,000
Scenario annual cost
$30.0M to $120.0M
Scenario cost / life protected
$60K
Short-stay stabilization facility: <14 days, peer support + clinician. Avoids acute psychiatric admission for ~50% of patients. Cost = real estate + staff.
Source: Boudreaux 2016; multiple descriptive studies
04. Tier 1D: System-Level Architecture (28-36)
028
Peer support specialists with lived experience in ED / outpatient
Modelled lives protected / yr (unverified)
1,000 to 4,000
Scenario annual cost
$10.0M to $40.0M
Scenario cost / life protected
$10K
Hire people with lived experience of suicidality into ED + outpatient teams. Improves engagement, reduces re-attempt. Cost = salary + training.
Source: Pitt 2013; VA peer-support studies
029
Mental health parity enforcement (insurance coverage mandates)
Modelled lives protected / yr (unverified)
5,000 to 25,000
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$1K
Mandate equal coverage for mental vs physical health. Unlocks latent capacity. Cost = legal + enforcement (recouped).
Source: US MHPAEA 2008; Trivedi 2011 Health Affairs
030
Tele-psychiatry for rural / frontier regions
Modelled lives protected / yr (unverified)
2,000 to 8,000
Scenario annual cost
$10.0M to $50.0M
Scenario cost / life protected
$6K
Video / phone psychiatric evaluation + therapy in regions with no psychiatrists. Cost = devices + broadband + reimbursement.
Source: Multiple 2020-2025 systematic reviews
031
National strategic plan for suicide prevention (state-level, multi-sector)
Modelled lives protected / yr (unverified)
5,000 to 20,000
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$1K
Whole-of-government plan: surveillance, means, training, treatment. Binds agencies together. Cost = coordination + analytics.
Source: US National Strategy 2024; AFSP state grants
032
Veteran suicide prevention (VA REACH VET, firearm safety, opioid management)
Modelled lives protected / yr (unverified)
500 to 1,500
Scenario annual cost
$20.0M to $60.0M
Scenario cost / life protected
$40K
Predictive analytics + outreach + lethal means counseling. VA suicide rate dropped vs civilian peer for first time in decades. Cost = staff + data.
Source: VA REACH VET 2017-2024
033
Indigenous / Aboriginal community-led suicide prevention (culture-as-treatment)
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$19K
Culture-as-healing programs (language, elders, land). Most effective for Indigenous adolescents, the world's highest-rate subgroup. Cost = community grants.
Source: O'Keefe 2016-2024; Australia Aboriginal-led programs
034
Aboriginal / First Nations community gatekeeper training
Modelled lives protected / yr (unverified)
300 to 1,000
Scenario annual cost
$1.0M to $5.0M
Scenario cost / life protected
$5K
Cultural adaptation of ASIST / QPR. Cost = train-the-trainer.
Source: Australian models; Canadian Inuit Tapiriit Kanatami
035
Out-of-home reconnection programs for LGBTQ+ youth rejected by family
Modelled lives protected / yr (unverified)
500 to 2,500
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$12K
Family acceptance cuts LGBTQ+ youth suicide attempts ~8x. Alternative: Trevors Project-style housing. Cost = family therapy + housing.
Source: Family Acceptance Project 2009-2024
036
Family Acceptance Project training for parents of LGBTQ+ youth
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$2.0M to $10.0M
Scenario cost / life protected
$7K
Culturally-competent family intervention. Lowers suicide attempts, depression, substance abuse. Cost = training providers.
Source: Ryan 2009-2024
05. Tier 2A: Means, Method, and Lethal-Means Infrastructure (37-45)
037
Zero Suicide Initiative (health-system framework)
Modelled lives protected / yr (unverified)
3,000 to 10,000
Scenario annual cost
$5.0M to $30.0M
Scenario cost / life protected
$3K
Comprehensive health-system quality improvement: screen, treat, follow-up, means, lethal means, transition of care. Adopted by 1700+ US orgs. Cost = QI infrastructure.
Source: Zero Suicide Institute 2014-2024
038
Aftercare / case management after psychiatric hospitalization (post-discharge outreach)
Modelled lives protected / yr (unverified)
2,000 to 7,000
Scenario annual cost
$20.0M to $80.0M
Scenario cost / life protected
$11K
Active outreach within 7 days of psychiatric discharge. Cuts 30-day re-attempt ~30%. Cost = case manager salary.
Source: VA suicide prevention continuum 2024; multiple trials
039
Assertive Community Treatment (ACT) for severe mental illness
Modelled lives protected / yr (unverified)
500 to 2,000
Scenario annual cost
$30.0M to $120.0M
Scenario cost / life protected
$60K
Multi-disciplinary team delivers wraparound care in the community. Reduces suicide attempt rate in SMI ~50%. Cost = team + travel.
Source: Multiple trials; Bond 2001 review
040
Mental health first aid (MHFA) public training
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$3.0M to $15.0M
Scenario cost / life protected
$3K
Train general public in first-aid style mental-health response. Improves recognition, referral. Cost = training programs.
Source: Hadlaczky 2014 systematic review; Kitchener & Jorm 2002
041
AI-screened social media (passive outreach, 24/7)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$1.0M to $10.0M
Scenario cost / life protected
$3K
ML models scan posts for crisis language, alert safety team who DM outreach. Saves lives at scale. Cost = platform + team.
Source: Facebook AI suicide-detection 2017-2024; Twitter (X) similar
042
Anti-bullying school programs (Olweus, KiVa)
Modelled lives protected / yr (unverified)
1,500 to 6,000
Scenario annual cost
$20.0M to $80.0M
Scenario cost / life protected
$13K
School-wide anti-bullying. Bullying is causal for ~10% adolescent suicides. Cost = curriculum + training.
Source: Farrington 2011; KiVa RCT 2010-2024
043
Sleep hygiene / circadian intervention (CBT-I) for depressed teens
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$2.0M to $10.0M
Scenario cost / life protected
$3K
Treat insomnia in adolescents. Insomnia doubles suicide risk. CBT-I is first-line. Cost = clinician training.
Source: Sleep Foundation 2024; multiple 2024 RCTs
044
School psychologist ratio mandate (1:250 / 1:500)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$100.0M to $400.0M
Scenario cost / life protected
$83K
Lower ratio = early identification. US current 1:1200 average. Cost = salary pipeline.
Source: NASP recommendations; Kutcher 2015
045
Adolescent depression universal screening in schools (PHQ-A)
Modelled lives protected / yr (unverified)
500 to 2,500
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$8K
Universal annual PHQ-A for all 12-18yr. Cost = screening + treatment pathway.
Source: USUSP 2014; multiple 2020 trials
06. Tier 2B: AI in Mental Health (46-54)
046
Postpartum depression screening (EPDS) + treatment
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$14K
Universal screening at well-child visits 0-12 mo. 10-15% postpartum depression. Cost = screening + treatment.
Source: ACOG 2018; Cox 1987 EPDS
047
Perinatal mental health home visiting (Nurse-Family Partnership)
Modelled lives protected / yr (unverified)
200 to 1,000
Scenario annual cost
$10.0M to $40.0M
Scenario cost / life protected
$42K
Trained nurse visits low-income first-time mothers. 30-year follow-up: 80% reduction in maternal suicide, child maltreatment cut 48%. Cost = nurse salary.
Source: Olds 1986-2024 NFP RCT
048
Esketamine single-dose emergency rescue for suicidal ED patient
Modelled lives protected / yr (unverified)
200 to 1,000
Scenario annual cost
$5.0M to $20.0M
Scenario cost / life protected
$21K
In-ED or in-psychiatric unit single dose to stabilize acute SI while long-term therapy arranged. Cost = drug + monitoring.
Source: Canuso 2018 ASPIRE I/II
049
AI voice biomarker screening for depression / Parkinson's / early dementia (Kintsugi, Ellipsis, Cordio)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$1.0M to $10.0M
Scenario cost / life protected
$3K
15-second voice sample detects depression severity via acoustic markers. Passive, smartphone-native. Cost = app + screening.
Source: Kintsugi FDA 2022; multiple 2024-2026 clinical validations
050
Clozapine for treatment-resistant schizophrenia (suicide reduction)
Modelled lives protected / yr (unverified)
300 to 1,000
Scenario annual cost
$10.0M to $40.0M
Scenario cost / life protected
$38K
Clozapine uniquely reduces suicide in schizophrenia (~85% drop) vs other antipsychotics. Cost = drug + ANC monitoring.
Source: Meltzer 2003; multiple meta-analyses
051
Universal Basic Income (UBI) pilot scaled to national - cash cures poverty cures death
Modelled lives protected / yr (unverified)
5,000 to 30,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$157K
$500-$1000/mo unconditional cash to all citizens. Finland Kela pilot improved mental health (PHQ score reduction). Cost = budget.
Source: GiveDirectly Kenya 2017-ongoing; Finland Kela 2017-2018
052
Conditional Cash Transfer for at-risk families (Mexican Oportunidades model)
Modelled lives protected / yr (unverified)
2,000 to 10,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$92K
Cash to poor mothers conditional on school/health visits. Reduces depression + suicide rate, especially adolescents. Cost = budget.
Source: Oportunidades (now Prospera) 1997-2019 evaluation
053
Cash transfers targeted at youth (Kenya GiveDirectly lump-sum)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$92K
Direct $500-$1000 to 18-25yr in high-suicide-rate communities. Lump-sum > monthly for some outcomes. Cost = direct payment.
Source: GiveDirectly Kenya 2017-2024
054
Free public college tuition + universal student stipend
Modelled lives protected / yr (unverified)
1,500 to 8,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$579K
Tuition-free higher ed + living stipend eliminates student debt-suicide link. Cost = budget.
Source: Norway; Scotland; Fulbright studies
07. Tier 2C: Targeted Populations - Youth, Veteran, Indigenous, LGBTQ+ (55-63)
055
Free public trade / vocational training (18 month coding, plumbing, nursing)
Modelled lives protected / yr (unverified)
1,500 to 7,000
Scenario annual cost
$200.0M to $1.50B
Scenario cost / life protected
$200K
No-cost career-track training for school-leavers without degree. Reduces unemployment-suicide. Cost = training infrastructure.
Source: Perry 2003-2018; European apprenticeship data
056
Job-guarantee program for the long-term unemployed (employer of last resort)
Modelled lives protected / yr (unverified)
2,000 to 10,000
Scenario annual cost
$1.00B to $5.00B
Scenario cost / life protected
$500K
Government pays living wage for community work (parks, libraries, care). Each 1pp unemployment drop yields about 1% suicide drop. Cost = wages.
Source: MMT job guarantee proposal; Eurostat 2020
057
Living-wage mandate + automatic minimum-wage indexation to median wage
Modelled lives protected / yr (unverified)
3,000 to 15,000
Scenario annual cost
$10.0M to $50.0M
Scenario cost / life protected
$3K
Boost minimum wage to 60% of median. Reduces financial stress, depression, suicide. Cost = private-sector.
Source: US state min-wage studies 2010-2024
058
Free universal childcare (0-5yr public daycare)
Modelled lives protected / yr (unverified)
1,000 to 6,000
Scenario annual cost
$200.0M to $1.00B
Scenario cost / life protected
$171K
Free daycare cuts maternal-depression suicide, allows women to remain in workforce. Cost = infrastructure + staff.
Source: Quebec universal childcare 1997-2004 evaluation
059
Universal paid family leave (6 months, both parents)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$200.0M to $1.00B
Scenario cost / life protected
$343K
6-month paid leave reduces postpartum depression, abuse, suicide. Cost = insurance pool.
Source: Sweden 1974; OECD studies
060
Universal paid sick leave (10 days/yr)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $300.0M
Scenario cost / life protected
$100K
Paid sick days reduce working-poor stress. Cost = employer mandate.
Source: US state paid sick leave studies 2010-2024
061
Universal pre-K (3-4yr public preschool)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$200.0M to $1.50B
Scenario cost / life protected
$283K
High-quality pre-K for all. ROI 7-10% per dollar via lifetime outcomes. Reduces adolescent suicide. Cost = infrastructure + staff.
Source: Perry Preschool Project 2003; Heckman 2006
062
Free universal school meals (breakfast + lunch)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $300.0M
Scenario cost / life protected
$100K
Universal school meals cut food insecurity + teen depression. Cost = food + staff.
Source: Sweden universal free school meals 1970s
063
Public broadband as utility (fiber to every home, $20/mo)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$200.0M to $2.00B
Scenario cost / life protected
$367K
Universal broadband enables tele-mental-health + reduces rural isolation. Cost = infrastructure.
Source: Estonia, Chattanooga municipal broadband
08. Tier 3A: School-Based and Family-Based Prevention (64-72)
064
Public mental health EHR open-API integration (FHIR) + 1-click 'record-only-on-consent' data
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$10.0M to $100.0M
Scenario cost / life protected
$18K
FHIR-enabled mental-health records with patient-controlled privacy. Reduces re-traumatization. Cost = standards + vendor contracts.
Source: US ONC Cures Act 2024; Argonaut project
065
Affordable housing trust fund (5% regional, mixed-income zoning)
Modelled lives protected / yr (unverified)
2,000 to 10,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$458K
Mixed-income public housing + housing voucher. Homelessness = 9x suicide risk. Cost = capital.
Source: Singapore HDB; Vienna social housing
066
Housing First for chronic homelessness (Pathways model)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $300.0M
Scenario cost / life protected
$100K
No-conditions permanent housing + wraparound services. Cuts chronic homeless suicide ~80%. Cost = housing + support.
Source: Pathways to Housing 1992-2024; Tsemberis
067
Section 8 / housing choice vouchers, fully funded (eliminates waitlist)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$917K
Universal housing choice voucher eliminates homelessness + cuts family suicide. Cost = HUD budget.
Source: US HUD 2023 waitlist data
068
Universal eviction-prevention cash transfer (one-time $3k to families facing eviction)
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$10.0M to $100.0M
Scenario cost / life protected
$61K
Emergency rental assistance cuts eviction + suicide spike. Cost = transfers.
Source: Multiple 2020-2024 ERAP evaluations
069
Universal foreclosure-prevention cash transfer + mediation
Modelled lives protected / yr (unverified)
200 to 1,000
Scenario annual cost
$10.0M to $100.0M
Scenario cost / life protected
$92K
Cuts mortgage-related suicide. Cost = transfers.
Source: HAMP 2009-2017 evaluation
070
Bankruptcy-medical-debt buyout (waive $10k medical debt per household)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$100.0M to $500.0M
Scenario cost / life protected
$171K
RIP-style debt abolition. ~60% of bankruptcies cite medical bills; linked to suicide. Cost = charity/budget.
Source: RIP Medical Debt model 2014-2024
071
Universal student-debt cancellation (federal + private, partial)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$500.0M to $1.50B
Scenario cost / life protected
$571K
Cancel $20k federal student debt. Cuts debt-stress suicide. Cost = budget.
Source: US 2024 cancellation models
072
Free public transportation in major metros (zero-fare buses + rail)
Modelled lives protected / yr (unverified)
300 to 2,000
Scenario annual cost
$100.0M to $500.0M
Scenario cost / life protected
$261K
Zero-fare transit cuts transit-cost-poverty link + reduces car accident suicide method. Cost = farebox offset.
Source: Tallinn 2013; Kansas City 2020
09. Tier 3B: Clinical Care Pathways and Follow-up (73-81)
073
Free universal contraception + IVF access
Modelled lives protected / yr (unverified)
300 to 2,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$478K
Unintended pregnancy + infertility both suicide-risk factors. Cost = services.
Source: Colorado Family Planning Initiative 2009-2024
074
Free or subsidized childcare for single-parent households
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$314K
Single parents are highest suicide risk among women. Cost = child care + tax credits.
Source: Multiple US state programs 2010-2024
075
Universal food stamps (SNAP expansion to 200% federal poverty line)
Modelled lives protected / yr (unverified)
1,000 to 6,000
Scenario annual cost
$200.0M to $1.00B
Scenario cost / life protected
$171K
Food insecurity doubles suicide risk. Universal SNAP at 200% FPL. Cost = USDA budget.
Source: USDA SNAP studies 2010-2024
076
Free school-supplies + uniform program (no-cost K-12)
Modelled lives protected / yr (unverified)
200 to 1,000
Scenario annual cost
$5.0M to $50.0M
Scenario cost / life protected
$46K
Eliminates child-debt-stigma factor. Cost = supplies.
Source: Multiple district programs 2010-2024
077
Free universal menstrual products in schools + public buildings
Modelled lives protected / yr (unverified)
50 to 300
Scenario annual cost
$1.0M to $10.0M
Scenario cost / life protected
$31K
Period poverty linked to female adolescent depression. Cost = supplies.
Source: Scotland 2018; New Zealand 2021
078
Universal home energy assistance (LIHEAP expansion, energy poverty elimination)
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$306K
Cold-home mental-health link; winter fuel poverty. Cost = energy subsidies.
Source: LIHEAP studies 2010-2024
079
Free public parks + urban green-space (3-30-300 rule implementation)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$200.0M to $2.00B
Scenario cost / life protected
$629K
Tree canopy + park access cuts depression & suicide. Cost = municipal capex.
Source: WHO 2016 Urban Green Spaces; multiple 2020-2024 studies
080
Urban heat-island mitigation (cool roofs, tree shade for low-income neighborhoods)
Modelled lives protected / yr (unverified)
200 to 1,000
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$458K
Heat waves spike male suicide (US 2024 study). Cost = infrastructure.
Source: Multiple 2020-2024 climate-health studies
081
Air-pollution reduction mandates (PM2.5 below WHO 2021 guidelines)
Modelled lives protected / yr (unverified)
1,000 to 5,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$917K
Long-term PM2.5 exposure raises depression & suicide. Cost = regulation.
Source: Multiple 2020-2024 ambient-pollution mental-health studies
10. Tier 4A: Poverty-Cures-Death: Cash Transfers and Income (82-88)
082
Lead-pipe replacement universal program (children's IQ + adult mental health)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$500.0M to $5.00B
Scenario cost / life protected
$1.6M
Childhood lead exposure predicts adult depression & suicide. Cost = infrastructure.
Source: Flint 2014-2024; multiple lead-exposure studies
083
Universal free community-college associate degree
Modelled lives protected / yr (unverified)
1,000 to 6,000
Scenario annual cost
$200.0M to $1.50B
Scenario cost / life protected
$243K
Tuition-free associate's degree. First-gen college goers see major mental-health lift. Cost = state.
Source: Tennessee Promise 2014-2024
084
Apprenticeship-job-matching platform (government-funded, free)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$157K
Apprenticeship pathway reduces youth unemployment-suicide. Cost = employer subsidies + matching.
Source: German dual education system 1970-2024
085
Free universal legal aid for housing, family, employment disputes
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$611K
Legal aid cuts stress-related suicide + domestic-violence escalation. Cost = legal services.
Source: Multiple civil legal-aid evaluations
086
Free tax-preparation + automatic tax-filing for low-income households
Modelled lives protected / yr (unverified)
100 to 500
Scenario annual cost
$1.0M to $10.0M
Scenario cost / life protected
$18K
Eliminates tax-stress + captures EITC + CTC lifts. Cost = IRS budget.
Source: IRS Free File; California ReadyReturn
087
Auto-enrollment in all benefit programs (no-questions-asked, opt-out)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$157K
Stigma + paperwork stops ~30% of eligible from enrolling. Auto-enrollment fixes. Cost = state.
Source: Social Security auto-enrollment 2024+; universal credit UK model
088
Universal child trust fund / baby bonds ($5-50k per child at 18)
Modelled lives protected / yr (unverified)
500 to 4,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$244K
Endowment at birth. Eliminates child-future-poverty suicide risk. Cost = budget.
Source: UK Child Trust Fund 2005-2011; US Baby Bonds proposed
089
Free universal preventive dental care (oral health-mental health link)
Modelled lives protected / yr (unverified)
200 to 1,500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$324K
Dental pain + visible tooth-loss leads to depression. Cost = dental services.
Source: Multiple 2020-2024 oral-health/mental-health studies
090
Free universal vision care + glasses (1 in 4 children have uncorrected vision)
Modelled lives protected / yr (unverified)
200 to 1,500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$324K
Corrected vision improves school performance + self-esteem. Cost = optometry.
Source: Vision Council 2024; multiple screening studies
11. Tier 4B: Poverty-Cures-Death: Childcare, Education, Housing (89-95)
091
Free universal hearing aids (age 65+)
Modelled lives protected / yr (unverified)
200 to 1,500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$324K
Hearing loss triples depression risk. Cost = audiology.
Source: Hearing loss-dementia-depression studies 2020-2024
092
Universal broadband-subsidized laptop/tablet for low-income students
Modelled lives protected / yr (unverified)
200 to 1,500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$324K
Digital divide cuts education + mental-health access. Cost = devices.
Source: Multiple COVID-era 2020-2024 device-distribution evaluations
093
Free tutoring (K-12 after-school program, evidence-based)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$314K
High-dosage tutoring (3x/wk, 50hr/yr) improves achievement + mental health. Cost = tutors.
Source: TEN Tutoring 2024 meta-analysis; Saga 2023
094
Universal sports / arts / music program funding (free after-school for all kids)
Modelled lives protected / yr (unverified)
500 to 4,000
Scenario annual cost
$100.0M to $1.00B
Scenario cost / life protected
$244K
Free extracurriculars cut teen depression & suicide. Cost = programming.
Source: Multiple 2020-2024 extracurricular evaluations
095
AI-powered personalized after-school / online tutoring for low-income (Khanmigo, Khan Academy)
Modelled lives protected / yr (unverified)
1,000 to 6,000
Scenario annual cost
$5.0M to $50.0M
Scenario cost / life protected
$8K
Khan-style AI tutor at scale. 1:1 adaptive help. Cost = inference.
Source: Khanmigo pilot 2023-2025; Sal Khan 2024
096
Free universal home-visiting nurse for new parents (first 2 years)
Modelled lives protected / yr (unverified)
300 to 1,500
Scenario annual cost
$200.0M to $1.50B
Scenario cost / life protected
$944K
Nurse visits first-time low-income parents. Cuts postpartum suicide, child abuse. Cost = nurse.
Source: NFP; Hawaii Healthy Start; Elmira trial
097
Universal paid bereavement leave (8 weeks after loss of immediate family)
Modelled lives protected / yr (unverified)
100 to 500
Scenario annual cost
$20.0M to $200.0M
Scenario cost / life protected
$367K
Bereavement is highest-risk acute stressor. Paid leave protects widow/parent. Cost = insurance.
Source: OECD studies 2020-2024
098
Universal compassionate-care leave (12 weeks for terminal-illness caregiving)
Modelled lives protected / yr (unverified)
100 to 500
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$917K
Family caregivers have 2x suicide risk. Paid leave protects them. Cost = insurance.
Source: Multiple state-level evaluations 2010-2024
099
Universal 'medical-financial-counselor' navigator (free, embedded in clinics)
Modelled lives protected / yr (unverified)
500 to 3,000
Scenario annual cost
$50.0M to $500.0M
Scenario cost / life protected
$157K
Trained counselor helps patients with bills, eligibility, debt. Cost = staff.
Source: ProPublica 2020; multiple navigator programs