Transforming U.S. Education to Prevent Youth Suicide

Abstract

Ready or not, American schools facing increasing rates of youth suicide must actively manage mental health crises and work to prevent suicide. Using insights from district-based fieldwork, we offer a sociological vision for building sustainable, equitable, and effective suicide prevention capacities across school communities.

“I’ve been in education for 30 years, and it’s a very different world today than it was 20 years ago,” a school principal we call Tammy sighed. “In all my years in education, I never worried that my students might die, but now every night. Every. Night. I say to myself, ’Please just let everyone live another day.’” If Tammy sounds a bit dramatic, well, it turns out the problem really is dramatic, and her concerns are shared by many who work in K-12 education. Any number of youth suicide deaths is tragic, but Tammy’s school has experienced disproportionately high losses during an era of unprecedentedly high youth suicide rates across the country. Today’s schools have little choice but to prepare to triage youth in crisis, prevent suicide, and respond effectively should deaths occur, all while continuing to educate youth.

It’s a frightening, maddening, and community-testing situation. Tammy and other leaders like her feel understandably underequipped. “We’re using old models,” the principal told us. “20th-century models for 21st-century problems.”

The Challenge

When kids walk through their schools’ doors, they often carry backpacks stuffed with heavy textbooks, Chromebooks, as well as armloads of the “stuff” of American youth—headphones, refillable water bottles, hoodies, and fidget toys. However, students and the adults who work in schools tell us that what we can’t always see is the invisible burden of unique, but socially rooted problems students may also struggle to bear.

If we are going to build 21st-century educational models that work to support young learners to become happy, healthy adults, youth are going to need substantially more support in school buildings. And this support needs to 1) function seamlessly within schools, acknowledging they are organizations with competing obligations and pressures, and 2) focus on more than moments of suicidal crisis.

Identifying students at risk of suicide and triaging them to care has been the standard school-based suicide-prevention approach—and for good reason. Existing interventions for suicide prevention and postvention are deeply valuable and should be adopted with fidelity in every school. They are, however, difficult to sustain over time, particularly in an educational era notorious for resource scarcity. And they are plainly inadequate. Youth suicide continues to rise in the United States.

Pursuing Solutions

Our research has been motivated by the imperative to reimagine schooling so that suicide prevention is sustainable, effective, and helps reduce inequality in society. To that end, we partnered with two Colorado school districts highly impacted by youth suicide. One is suburban, next to a major metropolitan area, and the other is peri-urban, spanning urban, rural, and small-town spaces. Both districts are 80% white, though they have different local cultures and resources, with the peri-urban district leaning significantly more conservative, with higher poverty and fewer community mental health resources.

Today’s schools have little choice but to prepare to triage youth in crisis, prevent suicide, and respond effectively should deaths occur, all while continuing to educate youth.

To date, we have completed over three years of ethnographic fieldwork. Our data, which is not currently available for replication (though it will be partially archived with the NIH’s Data Archive), include participant observations (shadowing school staff), interviews (with students, school staff, families, and community members, n=304), document and archival analysis, and surveys with families and school staff. Guided by insights from the sociology of education, organizations, and suicide, our empirical findings allow us to offer a vision for schools to improve suicide prevention.

This vision will require schools, families, and community stakeholders to collaborate closely, and it will, of course, require major investments. That means embracing schools as sites for mental health care and mustering many types of resources. A serious and holistic commitment to preventing youth suicide will start with a substantial influx of school funding and with considering schools’ overlapping community roles, attuning schools to mental health alongside academic achievement, and challenging community mental health stigma.

Funding is Fundamental

It’s no secret that U.S. schools are resource-strapped. They don’t have enough money, staff, time, materials, or space to meet their existing commitments, let alone confront a problem so daunting as youth suicide. We know the statistics about overstuffed classrooms, but it’s the same in counselors’ offices and on school psychologists’ caseloads: there aren’t enough and, if there were, there isn’t enough money to pay them. Some schools, particularly rural ones, have no counselors at all (let alone school psychologists); others see their counselors juggling caseloads far exceeding the recommended limit of 250 students per counselor (already high). These realities severely limit how much help children can find in school buildings.

Schools need the funds and the freedom to invest resources in the ways that will best meet the needs of their local student bodies.

Teachers are key, too, yet they rarely have sufficient time to plan or grade, let alone take on students’ well-being. “Please, help the faculty, staff, and community too,” one teacher implored. “We have all struggled at some point. [Our school has] been through a shooting, multiple student suicides… and now a pandemic. …We are totally exhausted and in survival mode.” Indeed, school mental health workers commonly shared a new pressure: providing emotional support to overwhelmed staff as well as students. Having worked under these tightening constraints, we learned, some school counselors planned to leave schools for private practice rather than burn out entirely.

If young learners are to become happy, healthy adults they must get more support at school.

Olia Danilevich via Pexels

Our vision, then, begins by advocating that schools need the funds and the freedom to invest resources in the ways that will best meet the needs of their local student bodies. If we are to change the trajectory of the youth suicide problem, though, a good portion of any increased funding must go to recruit and retain talented, caring staff. Schools need more on-site mental health workers and lower staff workloads—higher pay is key.

Embracing the Mental Health Mandate

We found plenty of tension around how, when, and to what extent schools should be in the business of tending to kids’ mental health. To be sure, education researchers have long urged schools to support kids’ psycho-social-developmental needs alongside their academic needs—a whole child approach. Public policy, however, has tended to further strain resources and impose high-pressure external academic accountability policies (like No Child Left Behind), largely ignoring students’ mental health. Parents, too, are often uncomfortable with the idea of school staff “meddling” in what one peri-urban parent asserted at a school board meeting was best “left in the hands of parents!” Another suburbanite declared: “Schools are where education is supposed to be happening. Schools are not about public health environments.”

Our survey data shows that most school staff believe that mental health cannot be ignored within their institutions, yet we observed staff in some schools who were less than comfortable with this idea. They preferred mental health be the domain of families or trained professionals (other than themselves). Amid such conflicting attitudes, there can be substantial institutional ambiguity about the extent and appropriateness of schools’ interventions in students’ mental health. In turn, the ambiguity undermines schools’ commitments to mental health, pushing them to prioritize other pressing organizational goals over suicide prevention programs and pre-planning safe and caring responses to tragedy.

We argue that society must embrace the fact that schools are already tasked with monitoring and responding to the mental health needs of our nation’s kids. School staff prepared to play their individually appropriate roles can gain confidence and skills over time. Staff from bus drivers to administrators can function as trusted adults who can listen to kids’ mental health concerns, help identify kids in distress, and connect kids with school mental health workers.

Improving suicide prevention in schools is possible, but it requires examining schools as organizations facing competing pressures and operating in tandem with a host of other social institutions.

Pixabay

To build confidence in schools as mental health organizations, not only must staff be trained to identify students at risk of suicide, provide in-school supports and interventions (e.g., safety planning), and offer helpful, informed referrals for additional resources, but families must also be trained to see schools as a resource when their child needs support. When parents, communities, school boards, and local, state, and national governments acknowledge this unavoidable social function of schools, it opens doors. It better positions schools to obtain necessary resources and to work in collaboration with leading suicide prevention scientists and organizations to develop evidence-based, effective, and sustainable strategies to support kids when and where they need it—often during school hours.

Currently, many innovative schools are doing this work. They have to, because suicidal kids are showing up in classes and counselors’ offices needing support. Safeguarding young people’s mental and physical safety is not ancillary work, but a primary function of our public schools.

In our research, we identified a “gold standard” school. Its holistic approach to student health is comprehensive and should serve as a model. Where some schools brought in outside mental health workers to offer therapy during school hours (billing insurance, including Medicaid, directly)—and school staff reported the practice was a wonderful resource— one instituted a fully embedded health center for students. Within it, students accessed vision and dental care, illness management, and sexual and behavioral health resources. A full-time behavioral health provider offered crisis intervention, counseling, and mental health assessments for students, as well as invaluable support to the school counselors. Embedding mental and physical healthcare into the school environment eliminated many of the barriers families experience accessing such care. Further, it allowed providers to identify and address some of the medical sources of young people’s mental distress.

Leveraging Existing Resources

In the face of high external accountability standards, schools have built substantial systems to support their organizational goals. These include multi-tiered systems of supports (MTSS), Professional Learning Communities (PLCs), and more. Historically, these systems have focused predominantly on academics and mandated academic standards, but they are flexible. That makes them a potentially great tool for incorporating mental health curriculum, interventions, and problem-solving into the daily work of schooling.

MTSS systems feature collective and data-based decision-making to identify and deliver interventions tailored to student needs. Those interventions are organized into three tiers: Tier 1 approaches can be applied to any student, while Tier 3 interventions are specialized for high-need students. PLCs focus on adults, providing learning communities in which teachers of similar subjects and staff with similar roles gather to discuss how to teach more effectively. We saw schools in our research that had adapted systems like these to incorporate aspects of mental health. Some, for instance, encouraged teachers to spend PLC meetings on social-emotional learning, by examining how their gradebooks communicated hope, self-worth, and other social-emotional things to students. Other schools included mental health in their MTSS problem-solving, often by considering mental health concerns as potential root causes of academic or behavior problems or by offering mental health interventions for academic problems.

"Behavior problems" are a common complaint in classrooms, and they frequently result in discipline, but behavior problems are not always understood by schools as potential evidence of mental health problems or trauma.

Additionally, when such pervasive and familiar systems are tuned to suicide prevention, it can reduce the burden of suicide prevention on individual staff members and increase their confidence that students who need help will get it. Embedding mental health into existing support systems is a positive response to the common refrain that suicide prevention is “everybody’s business,” as it bolsters adults and kids alike. After all, students whose well-being is supported do better academically; the goals of academic achievement and well-tended mental health are not—and should not be—at odds.

Children carry a lot more than just their backpacks into educational settings and schools need 21st century solutions to deal with concerns of modern childhood and adolescence in schools.

Mary Taylor via Pexels

Discipline, Punishment, and Trauma Responsiveness

"Behavior problems" are a common complaint in classrooms, and they frequently result in discipline, but behavior problems are not always understood by schools as potential evidence of mental health problems or trauma. In other words, schools need to address behavior problems, while also learning to see those problems as possible symptoms. Experiencing a traumatic event, for example, can be highly disruptive to a student’s learning abilities, can make conforming to school behavioral expectations challenging, and can significantly increase a child’s vulnerability to suicidality. If teachers punish students for behaviors that are a manifestation of trauma, the students can be further harmed and alienated from schooling. This suggests schools must pursue the root causes of student behaviors (and grades and attendance) and tailor interventions to the problems at hand.

Instilling trauma-responsive educational practices (see recommended resources for more on TREP) and drawing on restorative justice practices will accomplish this by building interconnectedness and trust while cultivating important life skills in students and disrupting the school to prison pipeline that too often sees school discipline entwined with the criminal legal system. Finally, students for whom coming to school is too challenging for their well-being will need meaningful alternative educational options—like small supportive schools or high-quality online education.

Addressing Stigma, Promoting Help-Seeking

The stigma surrounding mental health and mental illness is strong in the United States., well beyond its schools. And that stigma has proven deadly.

As much as it is important to embrace suicide prevention as the job of schools, some families and some children may never be comfortable having their child’s mental health discussed at or disclosed to schools. And yet school mental health safety nets rely on individuals disclosing distress (their own and others’). Safety nets also rely on an individual’s willingness to seek appropriate care, which sometimes includes hospitalization, therapy, or other forms of intensive psychiatric services. In our research, the shame attached to having mental health challenges or being diagnosed with a mental illness is all about how we anticipate and fear others’ judgment; open engagement with these topics and normalization of help-seeking as a society is the only way to undermine stigma and shore up school safety nets.

One way that we can reduce stigma as a barrier to help-seeking is by making it easy to report any time, day or night, when someone is having a mental health crisis. In Colorado, schools use an anonymous tip line called Safe2Tell that allows students, staff, and families to report concerns directly to school staff and the police. Though initially designed to prevent violence, like rampage shootings, in our observations, youth used Safe2Tell to report themselves or their friends when a suicidal crisis was imminent and when they did not know how what else to do. It helped: in a single year, in a single district, we observed approximately 8-10 youth who were at high risk of suicide or suffering severe psychological pain who were identified and connected with support because of Safe2Tell tips. Anonymous reporting appears to sometimes make it easier for kids to let adults know they or their friends need help.

Interviews, however, revealed problems. First, and especially after school hours, our interlocutors noted that police officers responded to Safe2Tell tips. Often without warning, uniformed officers would arrive at students’ homes to perform “wellness checks.” A quarter of families in our survey data were uncomfortable with this practice, feeling that it made for an intense and stressful experience. Parents and students of color were especially wary of police involvement, and students reported they were hesitant to use the tip line, especially if they the person they were concerned about was a student of color. Ultimately, we see value in anonymous tip lines. They help connect kids to care. We also concur with many suicide prevention experts and activists that police are not appropriate mental health first responders, particularly if we want mental health safety nets to function equitably.

Improving suicide prevention in schools is possible, but it requires examining schools as organizations facing competing pressures and operating in tandem with a host of other social institutions. School safety nets are stronger when all safety nets are stronger—when both rural and urban communities have accessible and trustworthy healthcare with the resources to respond to psychiatric needs, for instance, they are better able to prevent suicide. When resources are scarce, as they are in most districts, schools are forced to pare back, to do more with less, and to respond to youth suicide rather than work to prevent it.

Building out our vision will require all hands on deck. This includes the participation of sociologists and community-engaged researchers who can help determine whether new strategies actually work for schools. Even gold-standard suicide prevention interventions can fall apart in the face of day-to-day schooling. Scientists who understand how systems, structures, and local cultures matter to developing efficacious policy are crucial in helping all children get the support they need to maximize their life chances.