Pamela MorrisāPerez, Rachel M. Abenavoli, Adam Benzekri, Sarah RosenbachāJordan Ā· 5 authors
For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, and suicide rates among adolescents have been rising for the last 15 years. Suicidal thoughts and behaviors among adolescents were common before COVID-19 and have become an increasing public health priority in the pandemicā²s wake. In this Social Policy Report, we review evidence for suicide prevention strategies designed to address these rising trends. We make recommendations for federal, state, and local policymakers and practitioners; program developers in organizations that design and implement programming for youth; and academic and nonacademic researchers. Where research evidence is strong, we suggest legislation, funding, and implementation. In areas where gaps in evidence exist, we recommend program development and research. Our recommendations follow the order in a taxonomy adapted from the Centers for Disease Control and Prevention, beginning with strategies that change the structural conditions in which adolescents live and concluding with strategies that support adolescents following a suicide (i.e., postvention). We find strong evidence for, and recommend policy implementation of: restricting access to lethal means; LGBTQ+ affirming policies; screening for suicide risk in medical settings; and community-wide investments via the Garrett Lee Smith Memorial Act. In schools, we find benefits of, and recommend funding and implementation of, youth-focused programs. Even so, gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking. Finally, guidelines for response following a suicide loss focus on immediate support and are based on limited research; this is an area for program development and research. We recommend state-level policymakers restrict access to firearms via regulations and safe storage; public health officials implement firearm safe storage programs and build barriers on buildings/bridges; public health officials and health care providers distribute lockboxes for medications; and the Consumer Product Safety commission enact regulations that restrict the size of bottles for lethal over-the-counter medications. We recommend that state-level policymakers protect and implement strategies that treat LGBTQ+ youth equally and affirm LGBTQ+ identities (e.g., maintain same-sex marriage laws, protect affirming school environments/safe spaces for LGBTQ+ youth); state policymakers and school district/school leaders fight anti-LGBTQ+ legislation, policy, and practices that limit access to medical care, sports, representation in classroom conversations; and school leaders support LGBTQ+ affirming spaces (e.g., GSAs). We recommend that The Joint Commission1 update its recommendations to include universal suicide risk screening for adolescents; the Centers for Medicare & Medicaid Services at the Department of Health and Human Services require screening for suicide risk in pediatrics and emergency departments as part of routine care; and health care providers implement such screening practices. We recommend that the federal government increase funding for the Garrett Lee Smith Memorial Grants that provide funding to communities for suicide prevention activities in youth-serving organizations and for the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act of 2021 that offers suicide prevention funding to schools to implement effective programs. We also recommend that public health and school district leaders apply for such funding and implement evidence-based practices. We recommend that state and local policymakers fund and monitor school district- and school-level implementation of state-wide suicide prevention laws and that school district/school leaders ensure implementation of such laws. We recommend that the state and federal Departments of Education fund and encourage implementation of evidence-based school youth-focused programs,2 in tandem with school staff training programs, and that school district/school leaders implement such programs. We recommend that the National Committee on Vital and Health Statistics create national standards for suicide death classifications and require workforce training to reduce variation across place and persons that can lead to underreporting for minoritized racial/ethnic and LGBTQ+ groups. We also recommend that public health officials ensure that coroners and medical examiners receive such training. Engage peer leaders to spread messages of help-seeking as normative in schools, in youth-serving organizations, and on social media. Develop programs that address unique needs of groups at high risk (e.g., Indigenous, multi-racial, LGBTQ+, and rural adolescents). Also develop programs for racial/ethnic minority youth for whom there is limited Develop programs that support adolescent needs for and for the youth in the design of programs, youth and youth to Develop strategies that support the of adolescents have the loss of a peer to and research on the of economic policies to reduce on adolescent suicide death and research on policies and practices (i.e., and for minoritized racial/ethnic groups Indigenous, and adolescents). and on the of increasing mental health care on adolescent suicide on the of crisis across in implementation across and to recommendations for practices and gaps in program design and the of effective peer programs on minoritized racial/ethnic and LGBTQ+ adolescents and in a of school and to data for of suicide and thoughts and and that of and policy in Our on the following youth the of and thoughts suicide and thoughts of to and suicide do not include is an in which with an to but not is the for suicide research. The suicide is with in part of its as a and We the following for of thoughts and behaviors among which to the of suicide as a suicide that as a of the suicide social that an for of risk among in social groups. 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Engage peer leaders to spread messages of help-seeking as normative in schools, in youth-serving organizations, and on social media. Develop programs that address unique needs of groups at high risk (e.g., Indigenous, multi-racial, LGBTQ+, and rural adolescents). Also develop programs for racial/ethnic minority youth for whom there is limited Develop programs that support adolescent needs for and youth in the design of programs, youth and youth to the of effective peer programs on minoritized racial/ethnic and LGBTQ+ adolescents and in a of school and and suicide and for prevention a suicide to a suicide death is with and national guidelines reduce such research to the benefits of guidelines a suicide guidelines are on crisis response support and are based on limited research. 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