Youth Suicide Prevention is a Health Equity Issue

Efforts are needed to address disparities in youth suicide risk

Many populations have traditionally been underrepresented in suicide prevention and research efforts, yet these populations are experiencing rising rates of suicide and higher rates of suicidal thoughts and behavior.

Clinical suicide prevention efforts need to provide comprehensive, effective, and culturally appropriate care to youth populations, including (but not limited to):

• American Indian/Alaska Native youth
• Asian-American youth
• Black youth
• Latino youth
• Youth from other communities of color
• Youth who identify as lesbian, gay, bisexual, transgender, queer, or two-spirit (LGBTQ2S+)
• Youth in rural and medically underserved areas
• Youth involved with the child welfare system or those who have experienced family disruption
• Youth involved with the juvenile justice system
• Youth with special health care needs, including youth with developmental disabilities

Systemic inequities that impact youth mental health

• Racism
• Homophobia or transphobia
• Economic inequities
• Under-resourced schools
• Medically underserved communities

Pediatric health clinicians can promote health equity in clinical suicide prevention efforts

Pediatric health clinicians should be trained to understand and address the impact of systemic discrimination on health, and address these topics in practice:

• Youth and family experiences with systemic discrimination should be incorporated into clinical history taking and counseling discussions
• Pediatric health clinicians should discuss topics such as sexual orientation and gender identity in a way that is not stigmatizing or discriminatory, but promotes inclusion and non-judgmental listening

Universal suicide risk screening can help support equity in suicide prevention efforts:

• Universal screening helps ensure that specific questions to measure suicide risk are asked of all patients, not just those deemed by the pediatric health clinician to be high-risk (See “Screening for Suicide Risk in Clinical Practice,” below)
• Validated, evidence-based screening tools should be used to identify suicide risk
  • Importantly, more research is needed to establish whether existing suicide risk screening tools are effective in identifying risk in understudied populations
  • As the research progresses and because suicide is a pressing public health threat, the available evidence-based instruments can be utilized (See Conducting a Brief Suicide Safety Assessment.)

Pediatric health clinicians can help address disparities by connecting youth and families to accessible and culturally appropriate behavioral health supports (Two Critical Steps Before You Begin.)

Pediatric clinicians can build a welcoming practice to serve all patients

• Encourage clinicians and staff to recognize and reflect on their own biases and work to prevent these biases from impacting care delivery
• Use inclusive language and imagery in signage, materials, and office art
• Ask patients about their names and pronouns and use them consistently during clinical visits
• Use respectful language and trauma-informed care principles when interacting with patients and families
• Utilize translation services, interpreters, and assistive technology to support accessible written, electronic, and verbal communication
• Engage families and community members in program development/evaluation and solicit feedback on the practice environment and care received
• For more information, see How to Prepare your Clinic or Health System for a Suicide Prevention Program.