Which Strategies to Prevent Youth Suicide Should Be Priorities?

KingWith today’s post, Dr. King closes out CFYM’s series on youth suicide prevention. We acknowledge the collaboration of National Network of Depression Centers and Active Minds with Care for Your Mind and we appreciate their contributions to our community.

Cheryl King, PhD
Institute for Human Adjustment, University of Michigan

While evidence-based education, prevention, and treatment intervention strategies exist to address the problems underlying youth suicide, significant barriers prevent young people from receiving the kinds of help that can make a difference. Public policy can impact the availability of services, but there’s debate on how to invest resources.

No Single “Right” Approach
When it comes to public policy and funding to address youth suicide prevention, there’s no perfect evidence to indicate a single best or preferred strategy. I personally look at it as a large magnet and, with every strategy, we “pick up” more of those who are at risk.

Youth suicide prevention strategies can be conceptualized into three broad groups.

  • Universal strategies reach a broad population, such as through an education and/or awareness campaign;
  • Selected prevention strategies intervene with groups that are at high-risk due to life experiences, circumstances, or mental illness; and
  • Indicated strategies are generally mental health treatments and support services for people who are already suicidal or dealing with a severe mental illness.

We don’t have clarity on how to rank these strategies in terms of their impact on youth suicide prevention. That’s partly because so many of these efforts are small or underfunded, and partially because the strategies keep changing in response to what we’re learning in the field, which admittedly has a slowly-evolving knowledge base.

There’s currently debate about whether to reduce or enhance funding for “gatekeeper” training and awareness programs for teachers, primary care doctors, and others who interact with youth. The Substance Abuse and Mental Health Services Administration has spent millions on this through the Garrett Lee Smith Act, and now there’s consideration of investing more heavily in youth screening strategies in a variety of settings, including medical emergency departments. By answering a relatively small number of questions, students at elevated risk are identified and given a referral to appropriate mental health care providers.

Evidence suggests that such screening programs can recognize risk in teens and play a role in getting them some help. Most of these programs to date have been evaluated by whether they identify at-risk youth who have never received professional services and get them to help. However, our National Institute of Mental Health has published an intent to fund a large-scale youth suicide risk screening project that will examine reductions in suicide attempts, too.

Gatekeeper training and awareness programs can be valuable. There is some evidence among the adult population that primary care education and screening provides benefits. However, data show that only a subset of trained teachersthose who have a good rapport with teenstend to take the next step and express concern.

Some evidence suggests that school-based and peer-based support may have positive results. Two examples are Sources of Strength out of Rochester, Minn., a peer-based awareness and support program, and the Yellow Ribbon Suicide Prevention Program, which has a strong peer element.

Public policy also plays an important role on public mental health services with regard to program funding and workforce development. In particular, I would advocate for improving training for mental health providers, and strengthening the system’s impoverished accreditation requirements regarding training to work with suicide risk In psychiatry, psychology, and social work training programs.

Consumer Advocacy
Achieving effective policy changes requires greater collaboration among the many organizations focused on improving youth mental health. Just as we do in suicide prevention, narrowly-focused advocacy groups will need to acknowledge overlapping risk factors (e.g., depression, substance abuse) and be prepared to unify their efforts and pool resources.

Finally, let’s not forget the power of consumer advocates and individual, heartfelt testimonials. When organizations are advocating for change, testimony from those willing to share personal stories have a real impact.

Your Turn

  • Which youth suicide prevention strategies do you think should receive the most funding? Why?
  • How do you think the different mental health and other advocacy organizations might work together on the common goal of preventing youth suicides?

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