Death by suicide is a complex individual, relational and public health problem. The incidence of such deaths over the past two decades has increased nearly 30%, with half of states showing even higher rates. The Intermountain West and the Pacific Northwest are disproportionately burdened with high (and increasing) rates of suicide, especially among middle-aged adults and certain at-risk populations. Evidence shows that suicide can be prevented, and state-level strategies to stem the trend are evolving. With support from the Centers for Disease Control and Prevention, NGA Health convened state leaders from 13 states in the Intermountain West and Pacific Northwest in March 2018 to derive lessons and policy best practices for addressing the trend.