Suicide is a complex issue with devastating consequences that disproportionately affect young people. Schools, as central hubs of a child’s life, play a crucial role in suicide prevention by addressing behavioral and emotional difficulties that threaten to interfere with a child’s ability to perform academically. Schools focus on factors affecting academic achievement, and mental health interventions work toward improving behavioral health outcomes in home, school, and community settings. While schools are not responsible for meeting all mental health needs of students, most educators agree that schools should enhance social-emotional competence, character, health, and engagement (Greenberg et al. 2003). By implementing comprehensive strategies, schools can create a supportive environment that fosters mental well-being and reduces the risk of suicide among students.
Understanding the Problem
Suicide is a multifaceted issue with various contributing factors, including mental health conditions, bullying, trauma, and social isolation. Suicide is the 2nd leading cause of death for people aged 12-24 in the US, with roughly 3,703 attempts each year by high school-aged youth (CDC, 2020). Suicide kills more youth per year than all natural causes combined. Youth suicide deaths increased by nearly 40% over the past decade (MAHNY, 2019). According to NAMI (2022), teens want schools to play a big role in their mental health; they should teach about mental health and how to get services. In a recent study, the percentage of NYC public high school students reporting feelings of sadness or hopelessness increased from 27% in 2011 to 38% in 2021(Hamwey, 2024). Schools are often the de facto means by which kids get any mental health supports, so the importance of ensuring students have multiple ways of receiving services is central when tackling suicide.
Schonfeld and Kline (1994) report on two basic assumptions when dealing with any school crisis. The first: crisis situations are inevitable in a school setting. They are going to happen, and schools need to be prepared. If you are a solo clinician in a school, then it’s your job to make sure you know the protocols and procedures. The second basic assumption: crisis involves people and their personal reactions to the situation. What keeps a crisis in operation is that it’s not so much the incident but the reaction. When someone is in a crisis, it’s as if they have horse blinders on – they can only see what is in front of them. Anything else in the periphery is out of focus, out of consideration. Clinicians’ goal when confronted with suicide is to assess risk, listen empathetically, encourage appropriate help, follow school protocols, and encourage follow-up. Recommended risk assessment tools include Stanley-Brown Safety Planning Intervention (2008, 2021). A brief intervention to help those experiencing self-harm and suicidal thoughts with a concrete way to mitigate risk and increase safety. Columbia Suicide Severity Rating Scale (Posner, 2010). A semi-structured interview/flexible format whose questions get the appropriate answer allows you to gather enough clinical information to determine whether to call something suicidal or not.
The Role of Schools in Suicide Prevention
Adopted from the medical model for prevention, the use of a multi-tiered system of supports (MTSS) approach when addressing suicide prevention aims to prevent behaviors and mental health symptoms from escalating. Through these targeted and individualized family-centered services, schools work to improve child functioning in order to prevent and reduce the risk of suicide. The MTSS model (AIR, 2024), broken into three tiers, is familiar to most school professionals, given that it is utilized for many school-based prevention initiatives. The following proactive approach highlights how a school can implement interventions so that anyone in a school can get the right help at the right time.
Tier I – Universal interventions
- Incorporate mental health education into the curriculum to teach students about emotional well-being, stress management, and coping skills.
- Promote open conversations about mental health, reduce stigma, and encourage help-seeking behavior.
- Train staff to recognize the signs of mental health struggles and intervene appropriately.
- Student suicide awareness education
- Provide regular training for teachers, administrators, and staff on suicide prevention, mental health awareness, and crisis intervention.
- Offer support and resources to staff members who may be experiencing stress or burnout.
- Fold in Mental Health Literacy education in Health Classes
Tier II – Selective Interventions include selective strategies concentrating on 1) groups who may be at higher risk, 2) students exhibiting warning signs, and 3) students experiencing stressful life events that may put them at elevated risk. Interventions at this level will include social supports and key target points in time when screening for suicide risk may be prudent.
Early Intervention and Support Services:
- Implement screening tools to identify students at risk of suicide or experiencing mental health difficulties.
- Establish crisis intervention teams to respond promptly to students in crisis.
Creating a Supportive School Climate:
- Foster a positive and inclusive school culture that promotes respect, empathy, and kindness.
- Implement anti-bullying programs to address bullying and cyberbullying, which can contribute to suicidal ideation.
- Encourage students to participate in extracurricular activities and build strong social connections.
Tier III- Targeted Interventions are focused on individual students that are acutely affected by a suicide loss, are engaging in suicidal behavior, or are demonstrating acute suicide risk. Provide access to mental health professionals, such as counselors and psychologists, who can offer individual and group therapy. Schools collaborate with community mental health services, such as the New York Psychotherapy and Counseling Center, for those students whose short-term counseling may not be sufficient. They can offer psychiatric evaluation, medication management, and ongoing play or psychotherapy for the student and family members.
Effective Suicide Prevention Programs:
Several evidence-based programs have demonstrated success in reducing suicide risk among young people:
- Sources of Strength: This peer-led program empowers students to promote positive mental health and connect with supportive adults and peers. https://sourcesofstrength.org/
- Youth Mental Health First Aid: This training program teaches adults how to identify, understand, and respond to signs of mental health challenges in young people. https://www.mentalhealthfirstaid.org/population-focused-modules/youth/
- Question, Persuade, Refer (QPR): This training program equips individuals with the skills to recognize the warning signs of suicide, persuade someone in crisis to seek help, and refer them to appropriate resources. https://qprinstitute.com/
Postvention
The death of a student due to suicide presents many challenges to the school community and is often overlooked as part of the school response. The complex nature of suicide grief, the sudden, unexpected, and often violent aspects of this kind of loss, and the difficulty we have understanding and talking about suicide create circumstances that can leave school leaders in shock and struggling to meet the needs of staff and students (SPCNY, 2019). Preplanning is key in order to effectively deal with the post-crisis. Written protocols, policies, well-defined roles, and professional development specific to suicide loss are essential supports that enable school leaders and crisis team members to respond in a coordinated and effective manner. After a Suicide: A Toolkit for Schools, published in 2018 by the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center, contains many resources to be used in the immediate aftermath of a suicide death.
Demands and daily problems in schools produce a sense of urgency, and when suicide attempts or ideation occur, it makes the culture of schools more reactive than proactive and more remedial than preventive. Implementing a 3-tier mental health program and utilizing external clinical staff can assist in creating order in an environment that is often unorganized and fragmented. By pre-planning, schools can help prevent suicides and meet the needs of all students when they feel there is no one else to turn to.
Scott Bloom, LCSW, is Director of Special Projects at New York Psychotherapy and Counseling Center. He can be reached at SBloom@nypcc.org, www.nypcc.org, or 347-352-1518.
Resources
- JED Foundation
- The Trevor Project
- American Foundation for Suicide Prevention
- Suicide Prevention Resource Center
- Suicide Prevention Center NY
- Lifeline/Crisis Text Line: 988
References
Adrain, M, Lyon, A. Suicide and Self Harm Prevention in Schools. SAMSHA. 2018
AIR. Center on Multi-Tiered System of Supports. 2024. https://mtss4success.org/
American Foundation of Suicide Prevention. https//Afsp.org/statistics. December 2022
CDC. Risk and Protective Factors for Suicide. April 25, 2024 https://www.cdc.gov/suicide/risk-factors/index.html
CDC. Schools are the Right Place for a Healthy Start for Adolescents. CD. https://www.cdc.gov/healthyyouth/about/why_schools.htm
Greenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnik, H., & Elias, M. J. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58(6-7), 466–474. https://doi.org/10.1037/0003-066X.58.6-7.466
Hamwey M, Norman C, Suss R, et al. The State of Mental Health of New Yorkers. New York City Department of Health and Mental Hygiene. May 2024.
National Alliance on Mental Illness. Poll of Teen Mental Health from Teens Themselves. 2002. https://www.nami.org/support-education/publications-reports/survey-reports/poll-of-teen-mental-health-from-teens-themselves-2022/
Posner, K. et al. Columbia-Suicide Severity Rating Scale. June 2010. https://cssrs.columbia.edu/wp-content/uploads/C-SSRS_Pediatric-SLC_11.14.16.pdf
Schonfeld, D. J., & Kline, M. (1994). School-based crisis intervention: An organizational model. Crisis Intervention & Time-Limited Treatment, 1(2), 155–166.
Stanley, B. & Brown, G. The Stanley-Brown Safety Plan (2008, 2021). www.suicidesafetyplan.com
Suicide Prevention Center of New York State. A Guide For Suicide Prevention in New York Schools. 2019.
The Recovery Village. https://www.therecoveryvillage.com/mental-health/self-harm/self-harm-statistics/. 2024.
