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Youth suicide prevention, intervention, and postvention

Suicide is one of the most tragic and concerning issues of our time. As a school administrator, it is important to understand the prevalence of youth suicide and take a proactive approach to prevention and intervention.

Why this is important

  • Schools are uniquely positioned for the work of mental health promotion, early identification, and suicide prevention (Bersia, 2022; MacPhee et al., 2021). This occurs daily through consistent, ongoing support across the tiers.
  • School staff may feel uncertain about discussing suicide at school because they worry that they may say or do the wrong thing. Further learning in this area would promote awareness, skill, and readiness to act as they approach this complex topic (Hochhauser et al., 2020).
  • Youth suicide is a complex issue that is connected to a wide range of variables and influences beyond the individual, which are compounded by social and racial inequities and systemic barriers and biases (Government of Canada, 2023; Hochhauser et al., 2020).

Research about youth suicide

  • In Ontario, one in six students report serious thoughts of suicide.
  • Although rates of self-reported mental distress have increased since 2000, the percentage of suicide attempts, and rates of death by suicide, have been relatively stable over time
  • In 2016 and 2018, suicide was the leading cause of death for children aged 10 to 14 (19% in this age group), though it is still relatively rare (e.g., 48 recorded deaths by suicide in 2018 in Canada); intentional self-harm was one of the top three causes of death from 2016 to 2020. For adolescents aged 15 to 19, suicide was consistently the second leading cause of death (after accidental injury) from 2016 to 2020, but the raw numbers in this age group are substantially higher (208 in 2020 through 256 in 2018).
  • By around the age of 9, many children have a thorough understanding of both death and suicide.
  • Regardless of whether they understand the consequences of their actions, children may consider death as an option to end their emotional pain without fully understanding the finality of their actions.
  • During public health restrictions, like school closures in the COVID-19 pandemic, media reported a 200% increase in the use of community resources such as Kids Help Phone, with volume increased from 1.9 million interactions (i.e., calls and text messages) in 2019 to 4.2 million in 2020; increases of 20% to 30% for mental health referrals to pediatric hospitals were also reported. In spite of this, there has not been an increase in reported rates of death by suicide.
  • In Canada, transgender youth (aged 15 to 17 years) are five times more likely to report suicidal ideation and 7.6 times more likely to report a suicide attempt, compared to cisgender, heterosexual adolescents. For cisgender youth, same-sex attraction is associated with 2.5 times the suicidal ideation risk and 2.8 times the suicide attempt risk.
  • Youth living in the poorest households were least likely to report good-to-excellent mental health and were more likely to indicate that they have seriously contemplated suicide.
  • The prevalence of suicide among Indigenous Peoples in Canada is high and disproportionate to the Canadian population at large and has remained stable and in some places worsened.

How schools can help

Review your board’s youth suicide prevention policy and any procedural documents that outline intentional, evidence-informed, and compassionate strategies across the spectrum of prevention, intervention, and postvention. Your board’s mental health leader, along with school, board, and community mental health professionals, can be a resource in supporting your professional learning and that of school staff in this area.

  • Mental health promotion is an essential component of a comprehensive approach to suicide prevention. Your school’s work at tier 1 is part of suicide prevention.
  • Careful thought must be given when considering more specific suicide-awareness activities within school boards. This area of work is extremely complex and carries many risks. Consult with the mental health leader or a school mental health professional at your school and be familiar with School Menal Health Decision Support Tool: Student Mental Health Awareness Initiatives – Version for School Administrators.
  • Decision making should consider the best available research, resources available, clinical judgment, and other (cultural) ways of knowing. Consider the unique needs of students, using a culturally responsive and identity-affirming stance, which when aligned with evidence-informed programming will lead to not only meeting student needs but also improved outcomes for students.
  • When you become aware of a student experiencing suicidal thoughts or ideation, follow your board procedure. If your concern is urgent (e.g., suicide risk or risk to others/imminent danger), act immediately to activate school protocols. Never leave the student alone.
  • A trained mental health professional is responsible for conducting a comprehensive risk assessment, but a school administrator can provide the calming support needed to ensure that the student and others are safe.
  • If a comprehensive risk assessment is conducted, work alongside the mental health professional, student, and family to create a plan to address short- and long-term safety.
  • When a student dies by suicide or makes a serious attempt to die by suicide, it is a unique kind of tragic event requiring specific, intentional, and thoughtful action (often called postvention) at the system and school levels.
  • Board procedure can assist in ensuring that your response is aligned with best practices for school communities coping with the death of a student by suicide.
  • A Canadian study (Swanson & Colman, 2013) confirmed that young people (aged 11 to 18) are particularly susceptible to the idea of suicide and that those who know someone who has died by suicide are much more likely to consider or attempt suicide themselves. This is why we sometimes see clusters of suicidal behaviour in a school or community.
  • After a death by suicide, school communities are at risk for more suicidal behaviour for up to two years. These concerns of contagion highlight the need for intentional, well-thought-out postvention strategies responsive to the individual school needs. Postvention collaborative work involving schools, parents/caregivers, community mental health agencies, hospital, cultural and religious partners work together.
  • Memorialization after the death of a student requires thoughtful consideration. Decisions regarding memorialization should balance the desire to acknowledge grief as well as future impacts on students and staff. Permanent memorials are not recommended.

Warning signs of suicide

Changes in typical behavioursIssues related to pain and lossTaking active steps
  • homework quality declines and grades drop
  • daydreaming
  • misuse of substances
  • negative mood or signs of depression (sadness, irritability, reduced enjoyment of previously enjoyed activities)
  • sudden mood swings
  • neglect of personal appearance
  • withdrawing from classroom, extra-curricular activities, and peers
  • changes in sleeping or eating habits
  • unexplained absences from school
  • violent, rebellious, reckless, or thrill-seeking behavior
  • loss of an important relationship
  • death of a loved one, especially from suicide
  • loss of self-esteem (school failure, failure to achieve expectations)
  • family disharmony (divorce, parental misuse of substances)
  • family history of mental illness or suicide behavior
  • rootlessness and family mobility
  • serious physical illness
  • physical and/or sexual abuse/assault
  • mental illness
  • conflict with peers, lack of social connection, and/or social vulnerability
  • a withdrawn student suddenly becomes outgoing
  • giving away prized possessions
  • talking/writing about killing oneself, including on social media, journals, or through artwork
  • verbal or written remarks about being a failure, worthless, a burden and/or isolated
  • collecting or possessing items that could be used for suicidal behavior (lethal means)

What to do if you’re concerned about a student

Individuals often worry that discussing suicide and asking directly about thoughts of suicide will somehow put these thoughts into a student’s mind. As a result, many caring adults avoid the topic. In fact, there is no evidence to suggest that asking someone if they are having thoughts of suicide will increase their risk of developing suicidal thoughts. Rather, talking about suicide shows that you care and that you are available to help in difficult times.

  • remain calm—or try to convey calm even if you do not feel it
  • name the signs/things you have observed that are making you concerned
  • promise privacy but not confidentiality
  • ask if they are thinking about suicide
  • listen actively, allow for silence
  • validate the student’s feelings but not their thoughts of suicide or plan to die
  • reassure the student that there is help and they will not feel like this forever
  • provide constant supervision, even for a trip to the washroom
  • connect with your school administrator, as per your board suicide prevention protocol
  • support the student as you wait for additional help

Here are some words you can use:

Open the conversation

  • Hey, do you have a minute? I just wanted to check in and see how things are going.
  • Thanks for making a few minutes to speak with me. I’ve noticed that you seem really stressed lately. Do you want to talk about it?
  • I’ve noticed you haven’t been handing in your work. That’s not like you. Is everything okay?

Ask about suicide

  • It seems like things are really tough right now. Do they ever get so tough that you think about suicide?
  • Does it ever get so bad you think about ending your life?
  • Sometimes when people are feeling really down and they don’t think it’s going to get better, they think about ending their life. Have you had any thoughts about suicide? 

Reassure the student

  • That sounds so hard, especially since you have been dealing with it by yourself. But now I know, and you’re not alone anymore.
  • I want the best for you and I’m here to help. Thank you for trusting me enough to tell me what’s been going on.
  • I’m here to listen and I know some other people in our school who could listen, too.

If a student discloses that they have activated a suicide plan (e.g., ingested medications or substances with intent to die) this is a medical emergency and you must follow your board’s suicide protocol and call for an ambulance right away. The student should never be left alone – even to go to the washroom – unless it is unsafe for you to be with them.

American Foundation for Suicide Prevention (AFSP), Suicide Prevention Resource Center (SPRC) & Education Development Center (EDC). (2018). After a suicide: A toolkit for schools.

Ansloos, J. (2018). Rethinking Indigenous suicide. International Journal of Indigenous Health, 13(2).

Bersia, M., Koumantakis, E., Berchialla, P., Charrier, L., Ricotti, A., Grimaldi, P., Dalmasso, P., & Comoretto, R. I. (2022). Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis. E Clinical Medicine, 54, 101705–101705.

Boak, A., Elton-Marshall, T., & Hamilton, H. (2022). The well-being of Ontario students: Findings from the 2021 Ontario Student Drug Use and Health Survey. Centre for Addiction and Mental Health.

Decaire, C. (2022, April 18). Youth mental health organization needs volunteers to meet demand. Canadian Broadcasting Company.

Government of Canada. (2023). Suicide in Canada.

Hochhauser, S., Rao, S., England-Kennedy, E & Roy, S. (2020). Why social justice matters: a context for suicide prevention efforts. International Journal for Equity in Health, 19 (76).

Kingsbury, M., Hammond, N., Johnstone, F., & Colman, I. (2022). Suicidality among sexual minority and transgender adolescents: A nationally representative population-based study of youth in Canada. Canadian Medical Association Journal, 194(22), E767–E774.

Kupfer, M. (2021, January 18). Pandemic driving more young people to seek mental health help. Canadian Broadcasting Company.

MacPhee J., Modi K., Gorman S., Roy N., Riba E., Cusumano D., Dunkle J., Komrosky N., Schwartz V., Eisenberg D., Silverman M. M., Pinder-Amaker S., Watkins K. B., Doraiswamy, P. M. (2021). A comprehensive approach to mental health promotion and suicide prevention for colleges and universities: Insights from the JED campus program. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.

Statistics Canada, 2023). Statistics Canada. (2023). Table 13-10-0394-01 Leading causes of death, total population, by age group [Data set].

Statistics Canada. (2022). Youth mental health in the spotlight again, as pandemic drags on.

Swanson, S. A., & Colman, I. (2013). Association between exposure to suicide and suicidality outcomes in youth. Canadian Medical Association journal/journal de l’Association medicale canadienne, 185(10), 870–877.

The Youth Suicide Prevention Life Promotion Collaborative. (2023). Postvention across settings and sectors: A resource for community-based service providers.

Tishler, C., Reiss, N., & Rhodes, A. (2007). Suicidal behavior in children younger than twelve: A diagnostic challenge for emergency department personnel. Academic Emergency Medicine, 14(9), 810–818.