Asking About Suicide Is Vital for Suicide Prevention in Schools and Colleges

Every school can contribute to suicide prevention and save lives. Statistics show school-age children worldwide are at risk, from their early years to young adulthood.

Almost 16% of high school students and 8% of college students in the United States have seriously considered suicide, according to the Centers for Disease Control and Prevention.

In the U.S., nearly 10% of high school students attempt suicide each year, and suicide is the second leading cause of death among youth ages 10–24, CDC figures show. Around the world, suicide is the leading cause of death of adolescent girls, according to the World Health Organization.

The Columbia Protocol Is Helping Schools Save Lives and Target Resources

People working in academic settings can help save lives, increase school safety, and use school resources more efficiently by identifying students who are most at risk for suicide and directing them to the support they need. Schools also need to be better prepared when a student asks for help; many teachers report being approached by an at-risk child. And students themselves need to know the questions to ask a friend or classmate when they believe they have reason for concern.

The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), provides the right questions to ask. The protocol is the ideal risk detection tool for any school’s suicide prevention strategy because it’s:

  • Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them. Anyone can use it, including counselors, nurses, teachers, students, coaches, resident assistants, and social workers.
  • Efficient. Use of the Columbia Protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly identify the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
  • Effective. Real-world experience and data show that the protocol has helped prevent suicide.
  • Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research.
  • Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 140 country-specific languages.
  • Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to identify suicide risk, making it the most evidence-based tool of its kind.

Contrary to some fears, asking direct questions about suicide won’t make someone suicidal and might actually reduce suicidal thoughts, according to a review of more than a dozen studies published since 2001. That includes a study of more than 2,300 high school students that found the questions actually lowered distress for depressed students. Many students are relieved and thankful when someone asks them if they are thinking about hurting themselves, so they can get help. The risk is in not asking.

Case Example

CT Alliance to Benefit Law Enforcement worked with mobile crisis providers to develop C-SSRS tear off sheets, improving communication with hospitals where, upon arrival, they share the C-SSRS findings. A CT school counselor used the C-SSRS to identify a 4th grader who was suicidal. He was sent to mobile crisis services who confirmed his C-SSRS results. He was then brought to the hospital who provided counseling and safety planning. This timely intervention and continuity of care was all facilitated by each touch point using the common language of the C-SSRS.

Success Story

The Tennessee Department of Education

Tennessee has been at the forefront of suicide prevention for students. In 2007, the state became the first to pass and enact the Jason Flatt Act, which, under Tennessee’s law, requires two hours of suicide prevention training annually for all teachers and principals. In 2016, the state legislature enhanced the law to require that each school district adopt a policy on student suicide prevention, developed in consultation with school and community stakeholders, school-employed mental health professionals, and suicide prevention experts.

The Tennessee Department of Education strongly endorsed the use of the Columbia Protocol in school settings, and most Tennessee school districts have adopted the protocol as their standard screening tool. Dr. Kelly Posner, founder and director of The Columbia Lighthouse Project, hosted instructional webinars for school personnel in the state, teaching them how to use the Columbia Protocol to help students and other youth.

“This [protocol] has catapulted a transformation of practices by ensuring that individuals who may have thoughts of suicide get the help they need before it’s too late,” said Melissa Sparks, director of crisis and suicide prevention services for the Tennessee Department of Mental Health and Substance Abuse Services.

The Columbia Protocol’s usefulness and impact became evident just two weeks after Posner began training school personnel in 2013, when staff at one Tennessee school identified a 9-year-old boy as being at risk for suicide: His answers to the protocol’s questions revealed a previous attempt to take his own life. If the staff had not asked him the Columbia Protocol questions, he might not have received the care he needed.

The C-SSRS in Action

The Columbia Protocol is being used by schools and school systems across the U.S. and around the world, including in Israel, South Africa, and the United Kingdom. Nineteen states have enacted the Jason Flatt Act — which mandates youth suicide awareness and prevention training for educators — and many of those, such as Georgia and Tennessee, are using the Columbia Protocol as their risk assessment tool. Another example, at the local level, is New York City’s Department of Education, which has trained nurses in all 640 middle schools and many high schools on how to use the Columbia Protocol.

“I guess a little bit of me wanted to die.”

See how the protocol works in this demonstration of its use with a student.