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Toward Zero Suicide for Youth

Zero Suicide: An Aspirational Goal

One of the newest efforts in suicide prevention is the Zero SuicideInitiative. Health and behavioral health organizations that are a part of this effort are working toward zero suicide as an aspirational goal todramatically reduce suicides. Zero suicide is an important goal for all of our work in suicide prevention, and schools have a vital role to play.

With the passage of HB 198, the Jason Flatt Act, in 2015, school systems now have a framework to develop, implement, and sustain comprehensive systems of suicide prevention in their school communities. Project AWARE, the HB 198 Suicide Prevention Task Force, and partnerships with behavioral health providers are playing an important part in supporting school systems through education and training, and providing resources that have
been proven to work.

Children and Youth Suicide Deaths Have Increased In GA
In 2016, there were 57 suicide deaths of children between 5 and 17 in Georgia, a 78% increase from 32 suicide deaths five years ago in 2012. Work on reversing the steep upward trend will need to use a comprehensive, multidimensional approach.

This approach must include evidence-based practices in prevention, intervention, and postvention for suicide that are required in school system policies. Specifically, we need to teach children and youth skills to cope with the difficulties they encounter and to know how to ask for help from trusted adults when their difficulties overwhelm them.

At the same time, we need to teach adults how to be supportive, to listen when children do share their difficulties and suicidal thoughts, and to get helpfrom professionals trained specifically in how to work with suicide.

Upstream Programs can Prevent Suicide
Upstream prevention is the practice of targeting efforts “upstream” before significant troubles are encountered that might require someone being rescued later “downstream.” Prevention begins with upstream prevention, helping children to feel competent and cared for on solid
ground — so Positive Behavioral Interventions and Supports (PBIS) schools are already participating in suicide prevention by providing the solid ground of a positive school climate. An upstream evidence-based elementary program that has been proven to prevent suicide and a host of other negative outcomes is The PAX Good Behavior Game (, which reinforces on-task behaviors in the classroom. The Good Behavior Game can be integrated into the classroom beginning as early as the first grade, and two years of playing the game for part of the day retains the positive effects decades later.

Upstream prevention in middle and high school can directly address suicide by again promoting positive behaviors and giving hope, help, and strength messages to youth. Sources of Strength ( is an evidence-based program that uses peer
helpers to share experiences of coping through hard times and reaching out to a trusted adult for help, two skills that have been shown to help keep young people alive. Youth involve other youth throughout the school and the school year and promote an atmosphere of hope, help, and strength.

Yet while upstream prevention works for the vast majority of youth, there is still a significant number of youth who report seriously considering suicide and attempting suicide each year.

In the 2016-17 school year, more than 58,000 youth in grades 6-12 reported on the Student Health Survey II that they had seriously considered suicide within the last year, and more than 25,000 reported they had attempted suicide in the last year in Georgia. For these youth, intervention is needed as they are at risk for suicide.

The DBHDD Office of Behavioral Health Prevention has developed a media campaign that provides a direction for intervention — Spot the Signs, Talk about It, Take Action.
Knowing Warning Signs for Children and Youth at Risk of Suicide is Critical

Here are recently released consensus warning signs for suicide:
• Talking about or making plans for suicide
• Expressing hopelessness about the future
• Displaying severe/overwhelming emotional pain or distress
• Showing worrisome behavioral cues or marked changes in behavior, particularly in the presence of the warning signs above 

More information is available at

If any of these signs are spotted, it is important to talk about it with the youth. A common myth is that talking about suicide with a youth will causethe youth to think about suicide or even attempt suicide. The opposite is true. Talking about suicide prevents suicide by opening up avenues of support and help and reducing stigma.

But sometimes the youth who is thinking of suicide will ask friends not to tell and set up a code of silence. Codes of silence can be dangerous, not helpful, so youth must be encouraged
to reach out to trusted adults who can get help and set up ongoing support for the youth in school.

HB198 mandates yearly training for school personnel to help them support students who are struggling with thoughts of suicide. We recommend gatekeeper training, which teaches how to spot the signs and get the youth to help, be taken by all school personnel and refreshed yearly. Most schools have a protocol that school personnel who do spot the warning signs get the student help with the school student services personnel such as the school social worker, counselor, or nurse.

These student services personnel can then refer the youth and family to community behavioral health services where they can get ongoing care specifically addressing suicidal thoughts and behaviors. If help is needed to access services or in a crisis, help is available free 24/7 through the Georgia Crisis and Access Line at 800 715-4225.

The Aftermath of Suicide Requires Grief Support
If the worst happens and a member of the school community has died by suicide, it is important for the school community to provide grief support, called postvention, in the aftermath of the suicide and to plan carefully to implement upstream prevention and intervention strategies in the following years. Students in schools affected by a suicide death have a risk of suicide that is eight times higher than their peers in unaffected schools. Because
about half of Georgia’s school systems are in counties that have had a school-age youth die by suicide since 2011, the HB198 Suicide Prevention Task Force is presenting a series of 10 Suicide Prevention Summits in 2017, given in March and September for these counties focusing on Postvention as Prevention.

These summits are designed to be interactive. Teams from invited counties analyze their own Student Health Survey II data, learn best practices and available resources, and develop strategies for their school communities. Some school systems which attended the March summits are implementing their summit strategies system wide this school year.

Partners’ Efforts Are Producing Results; Work Must Continue
Suicide is complex. It is not clear why the number of youth suicides is trending up instead of down as we hope. But we can be encouraged by the trends that are being reported in the Student Health Survey II. Both the numbers and the percentages of youth in grades 6-12 who reported they had seriously considered suicide and who report they have attempted suicide
in the last year have decreased each of the last three years.

Our efforts are producing results, and there is more we can do. Each school system can commit to building its suicide prevention practices each year and sustaining the ones it has started. Behavioral health and schools can continue and expand their work together in school-based mental health. We can commit to supporting youth and parents as partners
in suicide prevention and celebrate their voices and creativity.

We can all join together in community coalitions to work together toward the goal of Zero Suicide. Preventing suicide is everybody’s business.

By Sally vander Straeten, ACSW
Suicide Prevention Coordinator
Office of Behavioral Health Prevention, Division of Behavioral Health
Department of Behavioral Health and Developmental Disabilities (DBHDD)