Suicide rates among children and adolescents increased 62% in the U.S. from 2007 through 2021, according to the Centers for Disease Control and Prevention; suicide is now the second leading cause of death among young people 10-14 years old and the third leading cause of death for those between the ages of 15 and 24.
Yet experts believe that children’s death by suicide is preventable. That is why the Cardinal Health Foundation, in partnership with the Children’s Hospital Association and Zero Suicide Institute at Education Development Center (EDC), created its Preventing Youth Suicide Collaborative, first launched as a pilot in 2020. The Collaborative brought together 39 children’s hospitals across the country to accelerate improvement in the identification and care of children at risk for suicide. For several years, teams within each of the hospitals participated in the Collaborative’s community of practice webinars and an annual academy to accelerate learning and culture change.
"At Cardinal Health, we are deeply committed to investing in work that helps reduce mental health stigma, raise awareness and increase access to resources and services," said Jessie Cannon, President of the Cardinal Health Foundation. "Our Collaborative is based on the unique needs of children and youth, and provides resources that empower healthcare providers to help reduce pediatric suicide and improve children's mental health."
Participating hospitals have adopted universal suicide screening protocols and built tools into electronic health records (EHRs) to create standardized documentation. Because access to firearms increases the likelihood of death by suicide for children and adolescents more than fourfold, most of the children’s hospitals have increased or improved counseling for families on safer firearm storage (called lethal means counseling).
Linda Mayes, MD, chief of child psychiatry at participating hospital Yale New Haven Health System in Connecticut, and chair of the Yale Child Study Center, said, “This initiative has transformed how we care for children’s mental health across every setting. It gave us a shared framework and empowered our teams to screen universally for suicide risk, intervene early, and respond with compassion. Most importantly, we’ve built a system where every child is seen, every concern is heard, and every risk is met with care and connection.”
Said Cannon, “We’re grateful to our partners, the Children’s Hospital Association and EDC’s Zero Suicide Institute, and we celebrate each of the participating children’s hospitals, who have created sustainable change that is dramatically increasing patient safety within their health systems.”
Another participating hospital is Boston Children’s Hospital (BCH), the largest pediatric hospital in New England. Its Department of Psychiatry provides acute psychiatric treatment, inpatient and outpatient services, and emergency mental health care.
BCH joined the Collaborative in 2023. However, even earlier, during the pandemic, the health system had launched a quality improvement initiative aligned with the Zero Suicide framework for system-wide transformation toward suicide prevention.
The hospital introduced a standardized suicide screening, assessment, and management protocol that incorporates the following tools:
To date, more than 600 behavioral health clinicians at BCH have been trained in the Zero Suicide approach. BCH also implemented the protocol in its three primary care sites.
BCH enhanced lethal means counseling for families in the emergency department (ED) by training clinicians and embedding documentation tools in its EHR. After just six months, this effort created a 66% increase in documented counseling for patients presenting with mental health crises in the ED. Lethal means counseling is an important safety intervention for both suicide and homicide prevention; after 12 months, more than 1000 patients and families seen at BCH ED received the counseling.
Today, BCH is committed to expanding and deepening its Zero Suicide efforts. Its priorities include extending suicide risk protocols to its specialty medical and surgical programs; expanding evidence-based suicide-specific treatments including Collaborative Assessment and Management of Suicidality (CAMS); strengthening the transition of care to better support patients post-discharge; tracking long-term outcomes for patients following psychiatric hospitalization and monitoring treatment results for high-risk patients across ambulatory programs.
Patricia Ibeziako, MD, associate chief quality officer for behavioral health at BCH, said, “The Preventing Youth Suicide Collaborative and Zero Suicide framework have standardized a suicide-focused approach to care. As we implement the framework, patients are receiving care that is safe, effective, and evidence-based.”
Editor’s note: If you or someone you know is struggling or in crisis, immediate and nonjudgmental help is available by calling or texting 988. The 988 Suicide & Crisis Lifeline provides free and confidential emotional support 24 hours a day, 7 days a week.