Suicide, Violence, and Behavioral Threat Assessment and Management (BTAM)

Understanding Violence as a Spectrum

Violence is often discussed in silos, suicide on one side, interpersonal violence on the other. In reality, they exist along a shared behavioral and psychological continuum. Public health frameworks, including those from the CDC, define violence broadly to include both self-directed violence (suicide and attempts) and violence toward others (homicide, assault, mass violence).

This unified lens matters because many risk factors overlap:

• Trauma and adverse childhood experiences

• Substance use disorders

• Social isolation

• Access to lethal means

• Untreated mental health conditions

Understanding this overlap is essential for prevention and is where behavioral threat assessment and Management (BTAM) becomes a critical tool.

National Data: The Scope of the Problem

Suicide (Self-Directed Violence)

Suicide remains one of the most pressing public health crises in the United States:

• Over 49,000 Americans died by suicide in 2023

• That equates to 1 death every ~11 minutes

• 12.8 million adults seriously considered suicide, with

  • 3.7 million making a plan

  • 1.5 million attempting suicide

• Suicide is the 11th leading cause of death overall, but:

  • 2nd leading cause of death for ages 10–34

Key disparities:

• Males account for ~80% of suicide deaths

• Firearms are used in over 50% of suicides

• Highest rates occur among older adults and certain rural populations

Importantly, suicide is often described as the “tip of the iceberg.” For every death:

• ~48 attempts occur

• ~325 individuals seriously consider suicide

Homicide (Violence Toward Others)

While public perception often emphasizes interpersonal violence, the data tell a different story:

• ~22,800 homicides occurred in 2023

• There are more than twice as many suicides as homicides in the U.S.

Patterns in violence toward others:

• Disproportionately affects young males

• Often linked to:

  • Community violence exposure

  • Economic instability

  • Substance use

  • Social/environmental stressors

While homicide is highly visible, suicide remains far more prevalent but less publicly discussed.

The Overlap: When Self-Directed and Violence Towards Others Converge

Research highlights a critical insight:

Individuals at risk of harming others often show prior self-directed distress or suicidal ideation.

In certain extreme cases (e.g., targeted or mass violence), studies show:

• A subset of perpetrators exhibit suicidal ideation before or during the act

• Some incidents end in suicide or “suicide by cop”

• Suicide is the second most common outcome in an active shooter incident

This doesn’t mean suicidal individuals are violent toward others, but it does underscore:

Violence risk is often preceded by escalating distress, not sudden intent.

Behavioral Threat Assessment (BTAM): A Prevention Framework

Behavioral Threat Assessment is a structured, multidisciplinary approach used in:

• Schools

• Workplaces

• Healthcare systems

• Law enforcement

Core Principle:

Focus on behavior, not profiles or diagnoses, and not only when a threat (self-directed or towards others) has been made.

Key Components:

1. Identify Concerning Behaviors

   • Deepening Desparation/Despair

   • Unusual/Unexplained Changes in behavior

   • Prepatory Behavior

   • Interest in Past Attacks

   • Fixation

   • Unusual Acquisition of Weapons or Weapons Expertise

   • Novel Violence/Aggression

   • Expressed or Implied Intent to Harm

   • Directly Communicated Threat

   • End of Life Planning

2. Assess Escalation Pathway (Pathway Towards Violence)

   • Personal Grievance, Ideation, Research and Planning , Preparation, Probing and Breaching, Violent Action

3. Evaluate Both Risks (click here for flyer)

   • Risk of harm to self

   • Risk of harm to others

4. Intervene Early

   • Behavioral health support

   • Crisis stabilization

   • Environmental safety measures

5. Monitor Over Time

   • Threat is dynamic, not static

Why Behavioral Threat Assessment Matters

Traditional models often rely on:

• Diagnoses

• Criminal history

• Static risk factors

BTAM shifts the focus to:

• Real-time behaviors

• Context

• Escalation patterns

This allows for:

• Earlier intervention

• More precise risk management

• Prevention of both suicide and interpersonal violence

  
  

A Public Health Approach to Prevention

Effective prevention requires moving beyond reactionary systems toward upstream intervention:

1. Strengthening Protective Factors

• Social connection

• Access to care

• Community engagement

2. Reducing Risk Factors

• Substance misuse

• Access to lethal means during crisis

• Chronic stress and isolation

3. Integrating Systems

• Healthcare

• Education

• Law enforcement

• Judicial

• Community organizations

4. Promoting Help-Seeking Behavior

• Normalize mental health care

• Reduce stigma

• Increase crisis access (e.g., 988 in the U.S.)

Final Thoughts

Suicide and violence toward others are not isolated problems, they are interconnected expressions of distress, environment, and opportunity.

The data are clear:

• Suicide is more common, but less visible

• Violence toward others is less common, but more publicized

• Both share overlapping risk pathways

Behavioral Threat Assessment offers a way forward:

• Identify risk early

• Intervene before escalation

• Treat violence as preventable, not inevitable

  
  

  

  
  

  -Author: Jordan Garza, Founder of Lifeline Strategies, LLC

  
  

  Lifeline Strategies specializes in community health, resilience, and evidence-based approaches to improving public safety and well-being.