By Martha Staeheli, Director, School Mental Health Initiative of the New England MHTTC
As deaths from suicide have increased 24 percent over the past 15 years, becoming the third leading cause of death for youth and young adults, schools have worked to strengthen their surveillance and prevention efforts to offer students hope and resources (CDC, 2020). In the wake of the COVID-19 pandemic, when more and more young people are experiencing depression and anxiety, students are also reporting that thoughts of suicide, suicide attempts, and completed suicides are rising (CHEGG, 2020). Many are concerned about a possible increase in suicide attempts and completions, but data are not yet available for suicide rates since 2020.
We know, however, that suicidal ideations and behaviors are an extension of the severity of the mental health crisis youth are currently facing, and school communities must respond with increased efforts at awareness and prevention. This article reviews the data we have about suicide and risk factors, reviews some of the components of suicide prevention efforts in schools, and provides preliminary guidance for those concerned about a student.
Facts about Youth Suicide and Who is at Risk
Every day, 125 Americans die by suicide, leading to 45,979 lives lost in 2020 alone (AFSP, 2022). While the highest rate of suicide occurs in older males and middle-aged females, the most significant increase in suicide risk occurs for people between 15 and 24 (CDC, 2020). Notably, white males are at the most significant risk of suicide (25.4 out of 100,000), but suicide attempts for girls aged 12-17 increased about 51% over previous years (CDC, 2020). Before the pandemic, 20% of youth reported mental health challenges; that number rose to 37-44%, with one in four considering suicide by the summer of 2020 (CHEGG, 2020).
Depression is the leading risk factor for suicide, but not everyone who dies by suicide is depressed or has a depression diagnosis. The socio-ecological model below provides a more holistic perspective on what contributes to higher risk (Central East MHTTC, 2021):
LGBTQ+ people are three times more likely than others to attempt suicide, with trans-identifying people at most significant risk.
After white males, Native American/Indigenous youth are most at risk for completed suicide (14.6 out of 100,000), with African American/Black males (12.6 out 100,000) close behind.
Youth who identify as belonging to communities of color and the LGBTQ+ community are at especially high risk.
The Basics of School-Based Suicide Prevention Programming
Comprehensive suicide prevention in schools requires a multi-pronged approach that should be concretely addressed in school and district-wide policies, and plans focused on prevention efforts, crisis planning, and postvention planning and support. Educators must be familiar with the legal, ethical, and district requirements regarding youth suicide prevention planning and intervention in their schools, including guidelines around reporting youth at risk (see Guidance For Educators for more information).
Advocating for comprehensive suicide prevention efforts within your school and district is essential for educators to work to reduce suicide among students. SAMHSA provides a comprehensive toolkit for those working within high schools (whose students are at greatest risk) to provide evidence-based guidance for educators. There are myriad options for schools looking to establish or enhance their suicide prevention efforts. Still, these programs usually focus on issues like:
Awareness: A key strategy to help prevent suicide among youth and deliver mental health support within schools is to increase awareness and understanding of suicide risks and warning signs as part of evidence-based practices and programming for suicide prevention. It’s essential that schools also recognize and enhance the protective factors that can strengthen youth resilience and support access to needed mental health resources.
Planning: Schools need to create clear and comprehensive plans and policies that address prevention, intervention during a crisis, and postvention. School personnel also need training in their roles and what to do if they think a student is at risk, including whom to notify and how to connect students to mental health resources.
Reducing Stigma: Stigma surrounding discussions about suicide and mental health challenges continues to be the single biggest obstacle to students seeking help. Dispelling myths about suicide is essential to creating a thoughtful and compassionate school community.
Screening: Screening for mental health symptoms and suicide risk is a primary component of suicide prevention within schools. However, it requires a district-wide commitment to addressing the considerations and consequences inherent in screening students and referring them to the appropriate resources.
Support: Suicide prevention efforts offer a valuable opportunity to assess and expand existing trauma-conscious preventive mental health resources and supports within the school community to provide guidance, make referrals, and support students in crisis. These supports begin with creating a culturally responsive comprehensive school mental health program and include education and support aimed at students, families, and community partners. Teachers, administrators, and school staff also need ongoing education and support when students have experienced a crisis or have died by suicide.
When You’re Concerned about a Student
There is a wide variety of ways that suicide prevention efforts in schools are structured, but many educators are still unsure about how to best to immediately help a student in distress. Educators and school staff are not mental health clinicians and are not responsible for diagnosing or treating mental health conditions. However, educators are often the first to notice when a youth is struggling.
It can be uncomfortable to begin a conversation about mental health with a student, but connecting with someone in distress is crucial. Let the student at risk know that you are concerned and care. Knowing another person cares enough to become involved and listen to them can greatly comfort someone experiencing suicidal thoughts. Here are a couple of ways to begin the conversation:
Let the student know that you have noticed a change in their behavior, feelings, or something they said.
It is important to simply describe what you have observed rather than use words that convey judgment, such as ‘good’ and ‘bad.’ If the person feels judged, they might feel embarrassed or withdraw.
Be honest and genuine in your concern.
Many educators are worried that they might do or say the wrong thing when faced with a student in crisis, including when they are concerned a student might be considering suicide or self-harm. Here are some general guidelines to help direct those conversations (Suicide Prevention Lifeline, 2022):
If you are concerned about the student’s safety, remember that it’s crucial to focus on safety and alert the trained personnel identified by your school/district’s school mental health or suicide prevention plan:
Stay with the student you’re concerned about and do not leave them alone.
Alert your administrators and emergency personnel as directed by your district’s policies.
Encourage the student to talk and help connect them to relevant support and resources.
Ask if the student is thinking of suicide or has a plan: listen and take any ideation or planning seriously.
Encourage safety, harm reduction, and immediate connection to professional support.
Follow up with the student and the school leadership/ mental health professionals in your school/district.
Effective suicide prevention programming requires clear policies and planning for all members of the school community. Evidence-based suicide prevention programs and interventions are widely available to proactively address the needs of diverse school communities and students who are at risk. Prevention and intervention should be a foundational component of comprehensive school mental health programming. An educated and responsive school prevention program gives educators the knowledge, skills, and empowerment to recognize students in distress and act in a compassionate, effective, and safe way to support students’ health and well-being and the well-being of families navigating these crises.
Please see these additional resources for more information:
ClassroomWISE: Well-Being Information and Strategies for Educators online course to enhance mental health literacy in school staff
Suicidal Awareness, Response, Safety Planning, and Postvention Learning Series from the Mountain Plains MHTTC
What Educators Need to Know: School-Based Suicide Prevention and Intervention from the Mid-America MHTTC
Strategies to prevent suicide from the CDC
American Foundation for Suicide Prevention. (n.d.). Risk factors and
American Foundation for Suicide Prevention. (2022). Suicide statistics.
Centers for Disease Control and Prevention (2018). Suicidal ideation and behaviors among high school students — Youth risk behavior survey, United States, 2019.
Centers for Disease Control and Prevention. (2020). Wide-ranging online data for epidemiological research. Underlying cause of death Results-2018.
Mayo Clinic. (2018). Suicide: What to do when someone is suicidal.
Central East Mental Health Technology Transfer Center (Central East MHTTC). (2021). Suicide risk fact sheet.
SAVE Suicide Awareness Voices of Education. (2022). Suicide statistics.
Suicide Prevention Lifeline (2022). Help someone else.
Suicide Prevention Resource Center. (n.d.a). Certain demographics are considered at greater risk for suicide than others due to underlying systemic issues and traumas.
Suicide Prevention Resource Center (n.d.b). Risk and protective factors.
Suicide Prevention Resource Center. (n.d.c). Warning signs for suicide.
Wyckoff, A. (2021). ‘It’s everybody’s problem’: Goal to end youth suicide unites experts, organizations. America Academy of Pediatrics.