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This brief is based on the presentation by Kiara Álvarez, PhD, EdM, Bloomberg Assistant Professor of American Health at the Johns Hopkins Bloomberg School of Public Health. Dr. Alvarez’s presentation was the third of three at the 2023 Oregon Family Impact Seminars. Information about the approach taken in Family Impact Seminars model can be found online HERE. We focus on nonpartisan, solution-oriented dialogue, with a focus on the impact of policies on families.

The topic of the 2023 Oregon Family Impact Seminar was Youth and Family Mental Health. The state of youth and family mental health in the US is concerning, especially for those living in Oregon. The state ranks 50 in the US for the highest prevalence of mental illness and has the lowest rates of access to care (Reinert et al., 2021). Oregon has 800,000 youth under the age of 18 and 21% of youth between the ages of 12 and 17 report having a mental illness (Hayden, 2023). In this brief, we summarize the content from Dr. Álvarez’s presentation on youth suicide prevention. National and statewide statistics were presented to introduce the issue. A multilevel prevention approach was described, emphasizing equity investments. The presentation also highlighted current research, interventions, and actionable opportunities.

Youth suicide is an urgent challenge for families

Suicide is the second leading cause of death among individuals aged 5 to 24 in Oregon (Oregon Health Authority, 2021). Recent data suggest that 30% of adolescent girls and 14% of boys reported suicidal ideation in 2021 (Gaylor et al., 2023). While there has been a 27% decrease in the state’s overall suicide rate from 2018-2021, a closer examination reveals that this decline is primarily among White youth, suggesting racial disparities (Oregon Health Authority, 2021).

Policy Implications

To comprehensively tackle the issue of suicide rates, attention must be given to structural solutions at multiple levels and addressing the underlying factors contributing to youth suicide. Moreover, culturally responsive resources and services are essential, calling for interventions that are culturally grounded, contextually relevant, and linguistically accessible.

Based on the information provided in this brief, and in line with current national and state reports (Morris-Perez et al., 2023; Oregon Health Authority, 2023b), specific actions can be considered by policymakers for preventing youth suicide.

• Develop and implement culturally specific suicide prevention programs that address the unique needs of institutionally underserved youth (e.g., LGBTQ+, indigenous, rural adolescents) to reduce disparities in access to mental health services.
• Ensure and monitor the delivery of mental health assessments and services during pediatric primary care visits.
• Restrict access to firearms through regulations and safe storage practices.
• Prioritize funding of community-based youth mental health services and ensure funding includes approaches to family engagement and involvement in services.
• Establish robust monitoring systems to track suicide events and rates, identify high-risk populations, and evaluate the effectiveness of prevention efforts.
• Implement evidence-based school youth focused mental health programs. Fund and monitor school district and school-level implementation of suicide prevention practices.
• Foster collaboration among various sectors, including education, healthcare, law enforcement, and community organizations, to create a comprehensive approach to treatment and prevention.

Multilevel suicide prevention: Characteristics and opportunities

The complex nature of suicide requires a multilevel approach to prevention (see Figure 1). First, universal prevention can be achieved by promoting healthy emotional development, fostering social support, and preventing adverse conditions and toxic stressors affecting youth and families. Next, early intervention needs to be provided through specialized services and supports to groups with specific risk factors before a crisis occurs. Last, treatment should include access to specialized care and services across youth-serving systems for mental health treatment and crisis response.

Figure 1. Suicide is a complex problem that requires investment in multilevel prevention (Alvarez, 2023 Oregon Family Impact Seminar)

Initiatives such as the US Air Force suicide prevention program illustrate the effectiveness of multilevel strategies. Employing universal and targeted prevention, policy change, and leadership involvement, the US Air Force achieved a notable reduction in suicide rates among Service Members (Knox et al., 2003). Similarly, Michigan’s investment in the TRAILS school mental health program demonstrated positive outcomes, such as the reduction of COVID-19 related distress among school-age youth (Gavin & Ollila, 2022; Rodriguez-Quintana et al., 2021). In Oregon, the Youth Suicide Intervention and Prevention Plan, led by the Oregon Health Authority, emphasizes a continuum of multilevel, evidence-based care (Oregon Health Authority Public Health Division, 2022).

Three elements are essential for implementing multilevel suicide prevention. The first element is state-level infrastructure, which includes a designated lead agency, cross-sector representation, data-backed initiatives, evidence-based approaches, and stakeholder consultation and training (Quinlan et al., 2021). Second, integrating pediatric primary care and suicide prevention strategies is a critical venue for youth suicide prevention with 80% of adolescents attending preventive healthcare visits (Kalb et al., 2019). Finally, acknowledging the lethality of firearms in suicide attempts, addressing firearm safety, safe storage, and restricting access is vital. Firearm suicides account for 80% of firearm deaths in Oregon (CDC, 2023a).

Investing in equity

Investing in equity within the context of youth suicide prevention is needed to reduce racial disparities. This investment begins with recognizing diverse risk patterns, such as elevated risks among American Indian/Alaska Native youth and rural residents (CDC, 2023b). Access disparities persist, particularly for youth of color experiencing suicidal thoughts, emphasizing the need to address lower rates of mental health service utilization (Cummings et al., 2010; Fontanella et al., 2020; Freedenthal, 2007; King et al., 2020; Nestor et al., 2016; Wu et al., 2010). LGBTQ+ youth face higher rates of suicidal ideation (The Trevor Project, 2023), underscoring the importance of implementing policies that foster protective school climates and social support (Hatzenbuehler & Keyes, 2013; Russell et al., 2010).

Mental health equity efforts in Oregon

In Oregon, the OHA’s Behavioral Health Equity and Community Partnership focuses on eliminating inequities in behavioral health across populations through partnership building, program development and implementation, and proposing new legislation (Oregon Health Authority, 2023a). Moreover, organizations such as Health Share of Oregon and Oregon AgriStress Helpline advance health equity in the state by bringing together resources and providing mental health assistance for specific communities with high rates of suicide (Branam & Myers, 2023; Health Share of Oregon, 2023).

Conclusion

A holistic approach combining preventative public health measures, clinical care, and community-driven health equity initiatives is essential for comprehensive youth suicide prevention (Alvarez et al., 2022). By reimagining systems of care and fostering collaboration across sectors, progress towards a future where the rates of youth suicide are significantly reduced can be achieved.