Creating a Safety Net to Prevent Youth Suicide

Youth and young adults had been experiencing rises in depression, anxiety and self-harm over the past decade.

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Suicide and suicidal behavior among young adults, teens, and in recent years, younger children are a major public health crisis. While the overall U.S. suicide rate decreased in 2020 for the second consecutive year, the decline was not experienced by all demographic groups; youth, young adults, Black and Hispanic males and multi-racial females all showed concerning increases in suicide rates during the early phase of the pandemic.

The potential for detrimental impacts of the pandemic on youth mental health has added to pre-pandemic levels of concern. Youth and young adults had been experiencing rises in depression, anxiety and self-harm over the past decade. The pandemic then led to new concerns about potential disruptions in psychological and social development. Many known protective factors such as social support, mentorship, community cohesion, and healthy coping strategies like athletics or other in-person or outdoor activities, were likely disrupted by the pandemic for some youth, while concerning risk factors — such as loneliness, feelings of marginalization, family stress, economic strain, increased substance use, or bullying — could have led to deterioration in mental health for many during the pandemic. New CDC data released in April 2022 finds four in 10 youth report experiencing persistent sadness or hopelessness, with girls double the rate of boys, and LGBTQ youth at very high rates.

The U.S. Surgeon General and other groups recently declared a state of emergency related to youth mental health. Suicide is the second leading cause of death among youth 10-17 years of age in the United States (and in many places globally), with significant disparities by race, ethnicity, gender, and sexual identity. Our children should grow, thrive and live long, healthy lives. Yet over a quarter of youth deaths in the U.S. are from suicide, which could potentially be prevented. Developing a “safety net” that could reduce rates of youth suicide is a critical and feasible goal, but adults working with youth in clinical and community settings haven’t necessarily been trained on how to respond and need a blueprint to guide actions that can reduce risk of youth suicide. The recent Surgeon General’s Advisory calls for immediate and coordinated responses to prevent youth mental health from becoming a second pandemic.

One glimmer of hope lies in scaling up the implementation of evidence-based suicide risk-reducing interventions. By working together, experts from many disciplines including policy, healthcare, mental health, neuroscience, economics, government, education, corporate sectors and more — must come together to truly prioritize brain health and create a safety net related to suicide. Suicide is a multi-faceted health outcome and therefore requires transdisciplinary research and cross-sectoral partnerships to attack the problem.

A recent example is in the field of pediatrics. The American Academy of Pediatrics (AAP) has been increasingly focused on the role pediatricians can effectively and feasibly play related to youth mental health and suicide prevention. AAP listened to their members — pediatricians and family members — who are voicing growing concerns about youth mental health and suicide. The most recent AAP survey of pediatricians found that 92% of pediatricians had a patient who disclosed suicidal ideation, 80% reported having a patient attempt or die by suicide — 48% in the past year.

As the premier public health organization focused on issues affecting youth, AAP made a decision to focus on suicide prevention by partnering with the American Foundation for Suicide Prevention (AFSP). While AFSP has suicide prevention expertise, they rely on partner organizations that can implement suicide prevention within their field. (See Project 2025, AFSP’s nationwide initiative to reduce the annual rate of suicide in the U.S. 20% by the year 2025.) In order to implement strategies to reduce youth suicide risk, AAP and AFSP developed a new resource, a Blueprint for Youth Suicide Prevention to bring suicide prevention to pediatric primary care, to schools and community groups where pediatricians serve as trusted resources. The blueprint contains granular guidance on clinical, community and policy-based suicide preventive measures.

In order to reach a level of scale commensurate with the need, policy efforts at federal, state and local levels are critically necessary to address a complex issue such as suicide. We need clinical system implementation and community education. For example, improving access to screening, detection, and early intervention for children and adolescents is key. An innovative method for pediatric primary care providers to have quick access to a child psychiatrist’s expertise to support their care of youth with more complex mental health conditions has emerged but is spotty across the 50 states.

Signed into law in mid-2019, the Texas Child Mental Health Care Consortium (TCMHCC) was formed with the state’s 12 publicly funded medical schools. TCMHCC is funded with $118.5 million in state funds to provide universal access to child psychiatry consultation in primary care through the Child Psychiatry Access Network (CPAN), urgent access to psychiatric telehealth care and referrals in Texas schools through the Texas Child Health Access Through Telemedicine (TCHATT) program, and expansion of workforce training and the public psychiatry workforce more broadly. Launched in May 2020, TCMHCC engaged 5000 pediatric primary care providers in CPAN and reached nearly 1.7 million Texas students through TCHATT in less than a year, including 12.5% Black and 34% Latino students—numbers proportionate to the broader child population of Texas. TCMHC provides an infrastructure that can be scaled up or down as needs change. The Texas legislature just took advantage of this by adding $113 million in American Rescue Act funds to ramp up all these programs in response to the ongoing mental health surge.

Another example of cross-sectoral innovation in Texas is the San Antonio Mobile Mental Wellness Collaborative (MMWC), which brings together five local nonprofits to provide a holistic approach to mental wellness care of children and their support systems. With the behavioral health status of Bexar County’s children at a dangerous point, what if you could remove the transportation and cost barriers of mental wellness resources by bringing the services right into K-12 schools. In less than two years, more than 23,000 students – as well as their families, teachers, and administrators – gained access to free and confidential mental health resources, and the program is expanding to more counties in Texas.

The good news is that stigma is diminishing and the public demand for mental health and suicide prevention resources has grown. We have a growing set of tools; the field of pediatrics is making suicide prevention a priority in 2022; innovation is occurring; and families and youth are ready to engage. Policymakers, pediatricians, mental health professionals, parents, and educators all have a role to play, and together, we can and we will make progress to save lives.

Tune into the KSAT Q&A at 6:30 p.m. Thursday on KSAT 12 to hear more about this project from Dr. Christine Yu Moutier, Chief Medical Officer for the American Foundation for Suicide Prevention.