Suicide prevention is an urgent concern for any of us working with young people. Rates of suicide among college students are distressing. According to the :
- Suicide is the second-leading cause of death among college students.
- Nearly 1,100 suicides are projected to occur on college campuses this year.
- Eighteen- to 24-year-olds think about suicide more often than any other age group.
- One in 12 US college students has made a suicide plan.
Additionally, the found that 11.4 percent of students seriously consider attempting suicide.
To better understand both the causes of suicide and how those who work with young people can intervene effectively, I interviewed several experts in youth and young adult mental health, including: Greg Burnham, founder and director of and ; Eric Beaudoin, PsyD, clinical director of ; Tony Issenmann, PhD, LMFT, founder and coach at ; Ryan McGinty, MS, LAC, executive director of ; and John Winton, founder and director, and Joshua Raybell, MA, LCPC, CDC II, clinical director of .
We discussed risk factors and warning signs for suicide and suicide attempts, as well as approaches that can strengthen mental health and well-being. While perspectives varied, there was unanimous agreement on two points: anticipating difficulty is critical, and meaningful connection is imperative.
Why Suicide Prevention Matters for IECs
College and school independent educational consultants (IEC) are often uniquely positioned to notice early warning signs. This requires asking illuminating questions, sometimes at the risk of seeming invasive. These questions can elucidate mental health issues and encourage students to develop emotionally healthy practices.
Several experts suggested that a standardized list of probing questions for all clients could help prevent vulnerable individuals from falling through the cracks. Potential questions are included in the comments of the experts below.
To support IECs further, the clinicians interviewed here have agreed to be available to IECs who have concerns about a client, or for clients to speak with directly if they wish to connect with a therapist or coach. These highly qualified professionals can help assess risk, guide planning, and recommend appropriate therapeutic or coaching support. You can find their contact information at the end of this article.
Shared Risk Factors and Warning Signs
Greg Burnham identified characteristics that may heighten someones risk for suicidal ideation, including:
- High levels of perfectionism
- Achievement-driven anxiety, especially in highly competitive academic environments
- Pursuing achievement without meaningful connection
- Transitioning from being a rock star student to feeling like a little fish in a big pond in college
- Having stressors such as parental conflict or roommate difficulties
Burnham recommends that IECs invite students to share openly in order to assess their coping skills and resilience. Guiding questions include:
- What do you do when you feel down?
- Have you ever felt like a failure or experienced rejection?
- What do you do if you feel overloaded or rejected? For example, what happens if a roommate situation does not work out?
- Have you always felt comfortable with your friend group?
Sometimes, success and a seemingly perfect life can be bigger triggers than failure; young people can feel a tremendous, unmanageable pressure to sustain such success forever.
The Power of Asking Direct Questions
Unless we ask questions, both pointed and more general, we may have no idea what a young person is experiencing internally. The following questions can help reveal deeper struggles:
- Have you ever had a time when things were not going well? Tell me more about it. How did you handle it?
- Do you talk to other people about your struggles? When is the last time you shared being human with someone?
- With whom do you feel genuinely connected?
- What is your internal world like, the part others do not usually see?
- What is your relationship like with your family? Who plays what roles? What do you do when you disagree with one another?
- Have you ever thought about suicide? What are your thoughts when the topic comes up?
Human Connection as Intervention
Ryan McGinty has extensive experience as both a therapist and a crisis responder. He explains that while somber, hopeless behavior is an explicit warning sign, many early indicators of suicide risk are far more subtle. We often see the first signs in declining grades, social withdrawal, or a growing lack of clarity about the future, he explains. When a young person feels trapped in a lose-lose situation, or like nothing in front of them is workable, the risk increases.
These patterns frequently manifest as changes in personality or emotional responsiveness. If someone is typically upbeat and resilient, and suddenly their mood shifts, the ways they relate to others shifts, or their level of engagement changes, it can be a sign of significant distress, McGinty notes. Additional risk factors may include depression, experiences of significant or perceived irredeemable loss, perfectionism, and hypervigilance, particularly when a persons identity or self-worth is tightly tied to achievement.
McGinty shared an example of a young man living at home who felt stuck and overwhelmed by every option in front of him: disengaged from school, unhappy at work, and refusing therapeutic support. He felt like every path forward was impossible. That kind of hopelessness can be paralyzing, McGinty says. With consistent support, a thorough risk assessment, and collaboration with his family, the young man was eventually stabilized and connected to appropriate treatment, creating a path toward safety and healing.
One striking statistic from McGintys years in crisis intervention is that the people who died by suicide were those the crisis team never reached. Having someone to talk to isnt a small thing, he emphasizes. Human connection impacts the frontal lobe, which controls higher-level cognitive functioning, including problem-solving, decision-making, and planning. When someone is dysregulated, overwhelmed, and spiraling, the presence of another supportive human being can interrupt that cycle.
Effective intervention, he says, requires more than simply listening: it demands attunement. Its not just saying, Im listening. Its watching the movie theyre playing in their head. Its understanding their subjective experience deeply enough to read between the lines so that they feel seen and understood.
When someone has an inadequate support system, or none at all, creating safety may involve hospitalization. But it can also involve developing a collaborative safety plan that the individual can display, share, and rely on as a roadmap. It turns the risk into a shared responsibility instead of something theyre facing alone, McGinty explains.
When in doubt, he urges action: If theres ever a question of someones safety, its important to intervene to ensure their well-being. Even if it creates a rupture in the relationship, its worth taking that risk if it could save someones life.
McGinty emphasizes that anyone, not only clinicians, can play a role in prevention. A concerned adult can encourage a young person to seek therapy, contact a crisis team in acute situations, or, as a last resort, request a welfare check from local law enforcement. What matters most, he says, is that we dont ignore the signs, and we dont assume someone else will step in.
Eric Beaudoin, too, stresses that the most important element in suicide prevention is true connection, and that this is more effective than therapy or any particular discussion. He corroborates the importance of really seeing someone.
Again, risking being invasive and asking specific questions to help someone open up is essential. Some questions he suggests include:
- When was the last time you cried?
- Have you been spending time with friends? Do you wish you could?
- Do you wish you had more alone time?
- Are your friends online? How? If they are on Instagram, that is quite a narrow slice of life; do you ever wish you had more time with them in person?
Deeper conversations are critical since young people are skilled at making everything seem fine. Questions cannot stop at How are you doing? and the answer okay is not sufficient. What does okay mean? Do you feel hopeless? Detached? Do you wish you had more in your life?
Another approach is to say, You told me everything is okay, you are getting by. I hear that; can you also talk about your ideal life? If you could snap your fingers and suddenly everything was better, what would that be like? If they say nothing, make it a multiple choice: more or fewer friends, a couple of really good friends, more time with the close friends you have now, etc.?
With these approaches, it is possible to assess if someone is completely unhappy.
Suicide can occur because of feeling rejection without hope of ever not feeling this way. Many people face rejection without the capacity to get better at handling it, so it leads to self-hatred, shame, comparison, feeling trapped, and the inability to imagine it getting better. One part of life can be going well and another terribly and the emotional intensity of one takes over the frontal lobe. Prevention comes first from connection and then seeing a way out.
Very few people are naturally asocial; most people want interpersonal relationships, so not having them is a barometer for suicidal risk. A healthy, sustainable, consistent group of friends or romantic relationship can keep someone alive; family may not be enough.
Nevertheless, is also useful to inquire about family relationships and to investigate the persons family culture. Sometimes reducing technology use can be helpful. Families can participate in this effort and make addressing technology use a part of their culture. Beaudoin explains that families often come alive doing this: creating tech-free days, learning about their adult childs online connections, listening unobtrusively while the young person is talking, planning time together, or spending some time sitting around and talking. Sometimes, just knowing someones musical tastes can help assess their emotional state.
Preparing Students Before Crisis Hits
Dr. Tony Issenmann emphasizes the value of intentional preparation for the transition to college as a core mental health strategy. He encourages students to anticipate challenges and co-create personalized plans for emotional, social, and academic well-being, before they’re in the thick of difficulty.
“Most young adults expect some stress in college,” he explains, “but fewer are encouraged to imagine in detail how they will navigate moments when things don’t go according to plan: when their roommate isn’t a fit, when the social scene feels lonely, or when academic pressure mounts.”
One practical approach Dr. Issenmann recommends is participation in a clinician-led peer group before or at the beginning of the college experience. These groups normalize difficulty, reduce isolation, and foster emotional readiness by helping students reflect on their expectations and explore shared experiences. Through this process, students not only develop a stronger sense of belonging but also begin to build adaptive coping strategies.
He suggests incoming students ask themselves:
- What do I expect this experience to look and feel like?
- What will I do if things feel harder than expected?
- How will I know Im slipping into a place of emotional risk?
- Who can I reach out to for support?
As part of this preparation, students can be guided to create a mental health strategy that includes:
- Knowing and saving the contact information for campus counseling services, local therapists, and crisis support resources.
- Developing simple plans for sleep, movement, nutrition, and screen time.
- Identifying early warning signs they might be struggling, such as isolation, disrupted sleep, or decreased motivation.
A key theme in Dr. Issenmanns work is helping students protect their values while pursuing both achievement and connection. This means encouraging reflection on what kind of social and academic environments they want to cultivate, and how to avoid coping strategies, like substance use or overwork, that might disconnect them from what they care about most.
Dr. Issenmann also delineated one subtle but significant warning sign: a sudden or uncharacteristic emotional upswing after a prolonged period of struggle. That kind of shift, particularly in students with a history of depression or suicide attempts, can sometimes signal increased risk, he explains. Its a reminder that prevention isnt only about noticing when things look bad; its also about staying attuned when things look unexpectedly good.
These strategies align with the broader model of thriving, which emphasizes emotional awareness, values alignment, and sustainable ways of meeting ones needs. Thriving in college, Dr. Issenmann reminds us, doesnt mean avoiding struggle; it means building the capacity to face it with clarity, connection, and care.
Technology, Medication, and Hidden Risks
John Winton and Joshua Raybell explained that people who might be at risk of suicide include those with a history of suicidal ideation or attempts, suicide in their family system, or recent significant loss. These risks are exacerbated if the individual is depressed or lacks the ability to problem-solve.
Warning signs include withdrawal, continued struggles despite success and therapy, and lacking joy in life, feeling only exhaustion and burnout.
Joshua Raybell explained that suicidal ideation and attempts are very complex psychological occurrences. He cited a study about how passive technology use is adding more fuel to this serious fire. This was a cohort study reported in JAMA in which there were 4,285 US adolescent subjects. High or increasing addictive use of social media and mobile phones were associated with elevated risks of suicidal behavior or ideation. Those with high or increasing social media use or high video game use had more internalizing or externalizing symptoms.
Raybell also shared that over the years of his professional career, he has come to understand suicide in terms of categories. The examples he gave came from his years working in youth and adult psychiatric units and addiction inpatient units. He provided two examples of concerning situations. The first includes individuals who are mentally ill and have demonstrated a history of unpredictable behaviors and for whom contracting for safety means little, not because of the character of the person but rather the unpredictability demonstrated over time tied to the mental illness. In this type of situation, the appropriate intervention requires keeping this individual in a safe environment.
The next example, from his experience working in mental health, delineates those whom coworkers considered least likely to end their lives: people everyone enjoyed and liked, and who seemed to be doing well with minimal visible struggle. The intervention that could be helpful is to encourage these people to talk about what is and is not going well and how they are dealing with each. Even for clients who appear upbeat, it is important to create a space to provide time and ask questions that encourage someone to talk about their internal world.
Another factor is medication. Sometimes, prescriptions can help individuals begin to rebuild healthier patterns in their lives. And other times they can make the suicidal ideation worse, and stopping the medication can help. Thus, anyone starting a new psychiatric medication is a potentially vulnerable person to suicidal thoughts or desires and that needs to be monitored.
No Single Answer, But a Clear Responsibility
We see, with this discussion, that suicidal ideation is complex and there is no black-and-white answer for prevention. Yet across all perspectives, there is shared acknowledgment that asking questions, fostering connection, and encouraging people to explore and share all the sides of their emotional states can save lives.
By Cynthia Cohen, MSPH, 51勛圖 (CO)
Below is the contact information for the panel of experts that have agreed to be available to consult about concerning cases.
Dr. Eric Beaudoin, PsyD
Executive Director,
207-441-8533
Greg Burnham
Founder and Director, and
[email protected]
Tony Issenmann, PhD, LMFT
幛棗喝紳餃梗娶,泭
[email protected]
828-560-5665
Ryan McGinty, MS, LAC
Executive Director,
928-284-2690
Joshua Raybell, MA, LCPC, CDC II
Clinical Director,
208-265-3651
John Winton
Founder and Director,
208-265-3651