Schools and universities. Schools, colleges, and universities often are viewed as institutional settings that provide good organizational contexts for screening and intervening for suicide risk. A wide range of school-based programs has been developed including: screening programs to identify and refer those at risk; didactic suicide and depression awareness programs; gatekeeper programs for adults who have contact with young people; combined peer support and gatekeeper programs, and skills-based and competency-promoting programs. Some programs combine more than one of these approaches. However, few programs have been systematically evaluated for short or long-term efficacy, effectiveness, safety or fidelity, or suicide outcomes, and the widespread implementation of some programs, such as suicide awareness programs, has been controversial. The awareness programs have found no gains, a lack of behavioral changes despite positive changes in attitudes, or have reported undesirable effects including more maladaptive behavior, reluctance to refer friends for help, potentially harmful changes in attitudes, and iatrogenic effects resulting from bonding amongst deviant peers grouped together for program delivery.100, 101 Positive or promising effects have been reported for some screening programs, some skills building programs, and programs that combine gatekeeper and peer education with screening and referral. 102, 103 Properly developed programs can be promulgated without fears of contagion. 104 Case-finding approaches which screen for depression, substance abuse and/or suicide risk and refer at-risk young people for treatment have been shown to effectively enhance the likelihood that students at risk for suicide will get into treatment 105 and offer safe 106 alternatives to the risks associated with didactic suicide awareness programs. Nevertheless, screening programs need further study to improve the specificity of screening tools, and to explore the extent to which those identified as being at risk have a short or longer term subsequently reduced risk of suicidal ideation or attempt.
In college-aged students online web-based screening can be delivered via personal computers. School and college group-delivered social problem solving and interpersonal therapy have shown reductions in suicidal behaviors, albeit in small samples, and online real-time CBT shows effectiveness for all ages.