Intervention and protection: navigating suicide prevention in higher education
Content warning: this article covers matters relating to suicide and mental health. If you are affected by the issues raised, there are services that can help.
- The Samaritans are open every day of the year, you can phone them for free on 116 123 or email jo@samaritans.org (response time: 24 hours)
- SHOUT 85258 is a free, confidential, 24/7 text messaging support service for anyone who is struggling to cope
World Suicide Prevention Day this year marks the beginning of a new theme set by the World Health Organization (WHO): Changing the narrative on suicide. In higher education, colleges and universities have suicide prevention approaches in place, informed by guidance such as Universities UK’s Suicide-safer universities.
Suicide continues to be a difficult but important topic to discuss. WHO’s theme this year recognises the need to reduce stigma around suicide in the hope that it may ‘create better cultures of support’, both at an individual and a policy level. As students prepare for the new academic year, the question for universities is, what can they do to support their students?
Awareness raising to reduce stigma
Much of the current guidance and support on suicide prevention in the higher education space is framed around the whole-university approach to student support. A core value of the whole-university approach is seeing students as people, people tied by innumerous threads to their studies, friends, hobbies, families, financial responsibilities, hopes and fears.
It is perhaps an important reminder that a study of suicide rates in the general population found that only 27% of those who died by suicide between 2008 and 2018 were known to mental health services.
Not being seen, not being heard, is precisely the problem that stigma engenders. Being seen as a number or a ‘high-risk’ is equally a way of not seeing the person behind the pain and distress.
If we were only to discuss suicide prevention in terms of risk factors and risk mitigation strategies, we would be in danger of playing directly into the stigma around suicide as something to be feared.
Earlier this year, TASO’s CEO, Dr Omar Khan wrote a blog post about balancing awareness raising and action, and indeed, it seems important to find ways of translating the momentum of suicide prevention guidance produced by the sector into effective actions.
Awareness raising can help to align suicide prevention with the whole-university approach. This will help ensure that both the risks and the protective factors are considered when designing and evaluating suicide prevention strategies. In this way, we can contextualise rather than pathologise the student experience, and we may be in a better stead to create the cultures of support that students need.
Research and evidence
At TASO, we host a Student Mental Health Evidence Toolkit, which summarises existing research measuring the impact of student mental health interventions. The toolkit is part of the Student Mental Health Project.
Understandably, a common question raised is: ‘Where is the evidence on interventions that support suicide prevention?’. The answer is a complex one. Though there are interventions that specifically aim to help students experiencing distress and who are deemed a risk to themselves, there are strikingly few of these that are evaluated rigorously.
The studies relating to suicide prevention in our toolkit mostly evaluate staff training programmes in US contexts. Considering the growth of partnership projects between universities and NHS trusts, we need more evidence specific to the UK healthcare and education context.
Prevention and intervention: from training to triaging
While developing the toolkit, we also found that prevention itself can be understood in different ways. More interventionist and clinical approaches include implementing triage systems, crisis support and systems for phasing students back into education after a break due to poor mental health. And more preventative approaches tend to address the broader population or implement interventions that educate staff or students to maintain good mental health and spot signs of concern in others.
In this sense, the interventions that would be considered in suicide prevention strategies would fall under a range of different intervention types in the toolkit. As our toolkit also categorises interventions by activity rather than outcome, many of the interventions would fall under the umbrella of ‘suicide prevention’ but are not grouped as such. This, we felt, fit better with the whole-university approach, allowing room for interventions to be considered for multiple aims.
Where should we go next?
These two approaches (the targeted and non-targeted) to preventative care are equally important but very different ways of mitigating risk. Crucially, they are also evaluated differently, and there is a lot of space here for further research. One question is of particular importance: how do we ascertain a mental health risk?
National Institute for Health and Care Excellence (NICE) guidelines published in 2022 warn against the use of tick-box suicide risk assessment tools as they can be inaccurate, ignoring crucial contextual factors.
Instead, NICE advocates for the use of ‘risk formulation’, where practitioners would have a conversation with a person in distress, discussing historical experiences and protective factors as well as risk factors. This serves as a good reminder that any predictive analytics or assessments of ‘at-risk’ students should consider the complexities of a student’s context to avoid potential blindspots.
The NICE warning also prompts further reflection on how we discuss suicide. That is, risk assessments are angled towards reducing the intensity of a dangerous situation, but risk formulation refocuses this, giving space for protective factors. Indeed, this difference between risk factors and protective factors is the very reason why the types of interventions addressing suicide prevention can vary considerably.
By keeping all the contextual factors in mind, both the design of interventions and their evaluations would be founded on a more holistic understanding of individual students and the student body.