New NN4Y Practice Resource for Youth Homelessness Service Providers to Inform Their Suicide Prevention Strategy

The needs of youth experiencing homelessness facing suicidal thoughts are too often overlooked in broader suicide prevention efforts.

Research is sobering. Suicide is the second leading cause of death among individuals between the ages of 10 and 34.[1] Studies have found that between 20% and 68% of young adults experiencing homelessness report having attempted suicide during their lifetime.[2] Young people experiencing homelessness may also experience trauma, family conflict or rejection, violence, substance use, isolation, and significant mental health needs—often while navigating systems that can be fragmented, difficult to access, or poorly tailored to their unique needs.[3,4]

Homelessness itself can compound risk. A young person sleeping outside, moving between couches, staying in shelter, or cycling through systems often struggles to access consistent health care or maintain relationships with trusted providers. Even when a young person wants help, barriers such as transportation, insurance, cost, identification requirements, immigration status, and long wait times can stand in the way.

However, experiencing homelessness or having specific risk factors for suicide doesn’t mean an individual will attempt suicide. Risk factors can increase an individual’s vulnerability, but they don’t determine what will happen. There is no definitive way to predict if someone will attempt suicide. Instead, understanding these risks can help providers identify which young people may need additional support, either from the provider or a separate mental health care professional.

This resource outlines ten distinct practices across four areas.

• Strengthening Protective Factors
  • Build Belonging and Supportive Connections
  • Look Beyond Suicide Risk in Isolation
• Recognizing the Warning Signs
  • Make Suicide Prevention Part of Everyday Practice
  • Train Staff at Every Level
• Helping Someone Who is Considering Suicide
  • Create a Clear Response Plan and Practice It
  • Ask Directly and Listen with Compassion
  • Develop Safety Plans with, not for, Young People
  • Know Your Community Resources Before a Crisis Happens
• Developing a Plan for Support After a Mental Health Crisis
  • Establish a Plan for Someone Re-Entering Services After a Suicide Attempt or Other Mental Health Crisis
  • Supporting the Community After Someone Dies by Suicide

Suicide prevention happens every day, not just before, during, and after a crisis. As people who work closely with a young person, service providers are more attuned and can notice changes in thoughts, behaviors, feelings, and appearance. Changes on their own may not be a warning sign, so it is important to talk to that young person to learn more about what they are experiencing. This, combined with considering the frequency, duration, and impact of the changes, will help a provider understand if they should provide additional support.

Providers can keep a list of potential warning signs to recognize and track in case they begin having a larger negative impact on a young person. They can also incorporate conversations about mental health and well-being into intake, case management, outreach, drop-in services, and ongoing relationships with young people to help normalize this type of support.

There is no single tool that will work in every setting. What matters is developing a clear process for when and how staff screen, what happens when concerns are identified, who responds, how young people are connected to ongoing support, and how to respond after a suicide death or attempt.

This resource was developed with feedback from youth homelessness service providers about the wide range of practices they use. We will continue to evolve this work as we receive new feedback. If you would like to share your experience with suicide prevention, please let us know!

Screening and Assessment

• Ask Suicide-Screening Questions (ASQ)
• Columbia-Suicide Severity Rating Scale (C-SSRS)
• PHQ-2, PHQ-A, PHQ-9

Training

• ASIST (Applied Suicide Intervention Skills Training): a more intensive intervention model
• QPR training
• safeTALK: an awareness-focused model
• Youth-specific mental health first aid

Suicide Prevention Frameworks and Resources

• American Academy of Pediatrics Blueprint for Youth Suicide Prevention
• American Foundation for Suicide Prevention
• CDC’s Public Health Approach to Suicide Prevention
• NAMI Ending the Silence: a free evidence-based, 50-minute session designed for middle and high school students
• SOS Signs of Suicide: a training for middle and high school students to be completed within a classroom setting.
• Suicide Prevention Resource Center
• Youth.gov: Youth Suicide Prevention
• Zero Suicide Framework

Suicide Prevention Crisis Support Hotlines

• 988 Suicide & Crisis Lifeline: Call 988
• If a young person is in immediate danger or experiencing a life-threatening emergency, call 911 or your local emergency number.

Broader Mental Health Crisis Support Hotlines

• Blackline by and for BIPOC Youth: Call/Text 800-604-5841
• LGBT National Hotline: Call 888-843-4564
  • LGBT Youth Talkline: Call 800-246-7743
• NAMI Teen & Young Adult HelpLine: Call 1-800-950-NAMI (6264) or Text 62640
  • NAMI National Warmline Directory: State/Local Directory of Peer-Run Phone Lines
• Trans Lifeline: Call/Text 1-877-565-8860
• Trevor Project for 2SLGBTQIA+ Youth in Crisis: Call/Text 1-866-488-7386
• Youthline: Call 877-968-8491 or Text ‘teen2teen’ to 839863