HD29 - Youth Suicide Prevention Plan

Executive Summary:
Senate Joint Resolution 148 directed the Commission on Youth, with the assistance of the Departments of Health, Education, and Mental Health, Mental Retardation, and Substance Abuse Services, to develop a comprehensive youth suicide prevention plan. The study resolution recognized suicide as the third leading cause of death among adolescents, as well as the significant increase in the rate of suicide among Virginia youth aged 10-19 since 1975. With the support of the departments identified above and significant input from survivors, service providers, and other stakeholders, the Commission undertook development of the plan.

A variety of methodologies were employed in this effort. Suicide prevention plans from other states were reviewed and analyzed. Suicide data were gathered at both the state and national level, including national data on suicide attempts and suicidal thinking. A large body of research was reviewed and analyzed, and workgroups were developed to provide guidance and feedback throughout the process.

In 1998, 30,575 people ended their own lives. More than 4000 were under 25 years of age. Three hundred seventeen (317) were children aged 10-14. (*1) The number of adolescent deaths from suicide has increased dramatically during the past few decades. From 1950 to 1990, the suicide rate for adolescents in the 15-19 year-old age group has increased by 300%. (*2) From 1980 to 1996, the rate of suicide among younger adolescents (10-14 years of age) has increased by 100%. Suicide is the third leading cause of death for children in these age groups and the ratio of attempted suicides to completed suicides is estimated to be 50:1 to 100:1. (*3)

Over 800 Virginians died by suicide in 1998. The suicide rate for young Virginians, aged 10 to 19, has increased an alarming 32% since 1975. In 1998, seven Virginia children, aged 5-14, were reported to have died from suicide. Another 50 children, aged 15-19 ended their lives. Recent statistics show that teenage (15-19 years of age) deaths related to suicide range from 53 to 57 per year in Virginia.

Approximately one Virginia teenager every week takes his or her own life. Reducing and ultimately preventing youth suicide in Virginia will require substantial, long-term, system-wide changes, which expand and enhance services for youth. Over time, a coordinated approach to implementation of the recommendations described in this plan should significantly reduce the rate of youth suicide and contribute to improving the overall health of Virginia's youth.


Consistent with the recommendations of the Virginia Department of Health Study of Suicide in the Commonwealth, the Commission on Youth recommends that the Virginia Department of Health take responsibility for developing, implementing, and monitoring a coordinated suicide prevention strategy. The Department of Education and the Department of Mental Health, Mental Retardation, and Substance Abuse Services should partner with the Virginia Department of Health in the development and implementation of some specific components, but statewide coordination by one agency is critical.

Recommendation 1:
Amend § 32.1 of the Code of Virginia to designate the Virginia Department of Health (VDH) as the lead agency for youth suicide prevention in Virginia and require reporting to the Governor and General Assembly on the status of suicide prevention initiatives.


Youth suicide is a complex problem; therefore, efforts must be designed to provide for broad-based dissemination of information to all citizens of the Commonwealth. This information includes:

• Prevalence and causes of suicide
• Need to talk to youth about suicide
• Services / supports available for youth and families.

Community-wide education programs reach families, students, youth in the work force, hard-to-reach youth in other sectors, and media personnel. Research has shown that youth facing depression and other difficult times are unlikely to contact a mental health professional. Rather, friends, family, and teachers are most likely those in a position to observe the youth's despair and to respond. This, and the fact that early intervention with depressed youth is essential, compels the organization of public awareness campaigns which address the warning signs and appropriate approaches for helping. As a result of increased knowledge, skills, and interest, suicidal youth are more likely to be recognized and assisted in seeking appropriate mental health care.

Recommendation 2:
Increase funding for the VDH and the Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) for their development and/or adoption of materials and dissemination of youth suicide prevention information throughout the Commonwealth.


Suicide contagion is a major concern among service providers and policy makers. Suicide acts following another's suicide have been linked with reporting practices in which the completed suicide was glorified or romanticized. Since media reports may affect the incidence of youth suicide, state and local policy makers should work together to influence media reporting practices regarding youth. Responsible reporting of suicide can have several direct benefits. Community efforts to address the problem can be strengthened by news coverage that describes the help and support available; as well as provides information about how to access assistance; that explains how to identify persons at-risk for suicide; or presents information about risk factors.

Recommendation 3:
VDH should make available to media professionals throughout the Commonwealth information about the responsible reporting of suicide (including specific guidelines developed by the U.S. Centers for Disease Control and Prevention) in order to reduce the risk of subsequent suicides.


School-based suicide prevention strategies involve a coordinated effort, reaching all levels of school staff. The purpose of school-based education efforts is to provide instructional content that parallels the community-wide public education campaign, so that youth, parents, teachers, and other adults are sensitized simultaneously to the issues and concerns, and to the knowledge and skills for preventing youth suicide. School-based programs are an effective method of disseminating information about suicide' to large segments of the youth population.

Recommendation 4:
The Department of Education (DOE) should revise the Suicide Prevention Guidelines to include criteria for follow-up with parents of students expressing suicidal intentions after initial contact is made.


Gatekeeper Training is designed to teach youth and significant adults specific strategies for recognizing and responding to suicide-risk youth and connecting them with persons capable of providing crisis intervention and support services. Gatekeeper Training is designed to prepare a broad spectrum of community members throughout Virginia to serve the protective functions of identifying and responding to youth with a high potential for suicide. Gatekeepers are trusted individuals who routinely have significant contact with youth and who are likely to observe high-risk behaviors. These Gatekeepers include:

• Health care providers
• School personnel
• Clergy
• Youth service workers
• Law enforcement and Court Service personnel

Gatekeepers do not replace professional mental health care providers, but are, more often, "natural helpers" in a youth's social network. Gatekeeper Training is a process by which these frontline persons acquire the skills necessary to accurately screen and refer high-risk youth.

Recommendation 5:
VDH and DMHMRSAS should develop and deliver Gatekeeper Training to designated audiences throughout the Commonwealth.

Recommendation 6:
The Board of Health Professions and all state agencies responsible for licensing or certification of youth-serving personnel should require suicide prevention education as a requirement for licensure or certification.


Youth suicide prevention is necessarily linked to mental health and emotional well-being. While it is recognized that youth in crisis and at-risk of suicide need immediate access to crisis intervention services, research also shows that early intervention and prevention services help to avoid the onset of crisis.

Comprehensive mental health services for children, adolescents, and their families include prevention, early identification and intervention, screening and evaluation, and a continuum of both non-residential and residential treatment services. A critical component of an effective system is an appropriate balance between more restrictive and less restrictive services.

To reduce suicidal behaviors and prevent suicide, high-risk youth, their friends and family members need immediate, 24-hour access to crisis intervention. Local crisis centers should be supported in their efforts to expand their service capacity, particularly in the implementation of 24-hour crisis hotlines.

Recommendation 7:
DMHMRSAS should continue to develop and implement the plan to provide comprehensive mental health services for children, adolescents, and their families.

Recommendation 8:
DMHMRSAS and VDH should increase the capacity of local communities to provide community-based crisis intervention and support services for children, adolescents, and their families.


Skill-building support groups are designed to provide a safe, comfortable environment in which vulnerable youths can learn and practice life skills to increase resiliency, strengthen protective factors and reduce risk factors. The target population for these groups is made up of youth who have been identified as being at-risk for suicide through screening, self-referral, or referral by parents, gatekeepers, and/or mental health professionals.

Increasing the availability of prevention and early intervention services for depressed youth are priority goals of the youth suicide prevention plan.

Providing school-linked mental health services will help to ensure that youth who need these services have access to them. Lack of social support, particularly family support, has been shown to increase the risk of youth suicide. Family support should include education about ways to support youth as well as teaching skills for family members. Youth should be served within the context of their families. A family-systems approach to mental health services will increase opportunities for successful prevention and intervention.

Recommendation 9:
DMHMRSAS should continue to expand the availability of comprehensive mental health services for children and youth at-risk for suicide, particularly helping localities to offer skill-building and support groups, school-linked mental health services, and family support I survivor services.


If professionals are to work effectively with youth at-risk for suicide, continuing training opportunities must be provided to support these professionals. Expected outcomes of clinician training include:

• Increased knowledge of the interpersonal and intrapersonal dynamics of youth at high-risk for suicide, psychosocial indicators of suicide, and necessary supports for these youth;
• Increased skill in the assessment of youth at-risk;
• Increased skill in individual therapeutic methods for youth at-risk and their families; and
• Prevention of worsening condition of youth and decreased risk and incidence of suicide.

Recommendation 10:
DMHMRSAS and VDH, in cooperation with university medical centers, health science centers, and professional organizations should develop, implement, and evaluate curriculum and training plans to increase the knowledge and skills of clinicians and others who work with youth at-risk for suicide and their families.


Currently, Virginia has no system for monitoring suicide attempts among youth. A suicide attempt data system will provide a comprehensive surveillance instrument for understanding suicide attempters who are present in Virginia hospitals. Monitoring suicide attempts in Virginia is necessary to better understand the occurrence of attempts by youth in the Commonwealth. Data gathered will help planning of activities and evaluation of the success of suicide prevention activities.

Recommendation 11:
VDH should design and implement an adolescent suicide attempt data collection system to determine the magnitude of the problem, as well as the following characteristics of youth who attempt suicide: demographics, service access, and behavioral characteristics.

Recommendation 12:
VDH should improve the system for reporting external cause of injury (e-codes) by providing training to designated reporters and by requiring e-code reporting for emergency room admission in selected sites around the Commonwealth.


Both process and outcome evaluation of all components of Virginia's plan are critical to ensuring its success. The Department of Health may wish to contract with a university partner to conduct certain aspects of the comprehensive evaluation.

Recommendation 13:
VDH should coordinate comprehensive evaluation of all aspects of the suicide prevention program.

Recommendation 14:
The General Assembly should appropriate funds to the Department of Health, the Department of Mental Health, Mental Retardation, and Substance Abuse Services, and the Department of Education to implement the youth suicide prevention initiatives described in this plan.
(*1) National Center for Health Statistics Vital Statistics System. "1998 Leading Cause of Death Reports."
(*2) Centers for Disease Control and Prevention. "Programs for the prevention of suicide among adolescents and young adults." "Morbidity and Mortality Weekly." 1994:43:1·7.
(*3) Hussain, SA. "Current perspective on the role of psychological factors in adolescent suicide." "Psychiatric Annual." 1990:20:122·27.