Sept. 30, 2018- In 2001, the American Foundation for Suicide Prevention was approached by two families, both of whom had recently lost a child to suicide while they were attending college. Like many families who have experienced loss, they came to AFSP with a very important question: Why?
AFSP began as a research organization: the natural outcome of several families who’d experienced suicide loss banding together with researchers who wanted to learn more about suicide prevention. After having been approached by these new families, with a specific focus on college-aged students, we decided to take a research-based approach to learning more.
At the heart of every research study is a set of questions used to formulate a hypothesis. The study is designed to address, or perhaps answer, each question.
The first several questions presented to AFSP began with, “Why…?” Why did my child die by suicide? Why, more generally, are college students at risk for suicide? Why, if mental health resources are available, do students who are at risk not reach out for help?
The final question began with the word, “how.” How can we identify at-risk students and encourage them to engage in mental health services?
To answer this set of questions, AFSP formed a workgroup with the goal of better understanding suicide risk among college students. To reach distressed students, we needed to find out what was preventing them from reaching out for help.
Late adolescence and early adulthood is often a challenging developmental period that coincides with the onset of many mental health conditions and substance use disorders. For college students, the stress of general age-related transitions can be intensified by the social and academic stressors intrinsic to campus life. The American College Health Association National College Health Assessment shows that each year, one in three college students report “feeling so depressed that it was difficult to function.” One in ten said they have “seriously considered attempting suicide.” That same survey found that despite the availability of free or low-cost mental health services on most college and university campuses, only 27 percent of depressed students were receiving mental health treatment.1
According to the National Survey of College Counseling Centers, which has been conducted annually since 1980, fewer than twenty percent of college students who die by suicide had sought services from their campus counseling center. Many factors appear to contribute to students’ reluctance to seek mental health services. Negative attitudes toward mental health treatment, sometimes rooted in past experiences, have been found as key barriers among young adults. Other barriers to treatment among young people include the fear of being stigmatized by peers, cultural beliefs that equate mental health problems with weakness, and fear that seeking help for suicidal thoughts or behaviors may lead to involuntary removal or mandatory leave-of-absence.
In 2001, the internet was just beginning to flourish as a place for innovation and anonymity. The workgroup decided that to reduce barriers to help-seeking, we needed to create a safe, confidential, and anonymous space online, through which we could better learn about their distress. Students would therefore be able to use the internet to anonymously connect with a campus mental health professional, who could engage them to look at and resolve barriers and resistances to mental health services.
Once we had the idea of how to reduce barriers to help-seeking, we needed a way to measure distress. Included on the online platform we would need to build a screening mechanism to measure risk.
The next step was to address the last question: How can we encourage students to engage in mental health services? The workgroup added a mechanism that would enable a campus counselor, after reviewing a student’s questionnaire, to personally follow up with them via the online platform, notably while allowing them to remain anonymous. Within this confidential online dialogue, the counselor would be able to answer any questions or concerns the student has, provide the student with information about available mental health services, and recommendations for engaging in these services based on the student’s answers.
We conducted our research project at two universities between 2002 and 2005. By the time this three-year pilot study was over, not only had we learned about help-seeking among distressed college students, we discovered – to our surprise – that we had developed an online program that could successfully reach students who may be at risk for suicide, reduce their barriers to help-seeking, and increase engagement among at-risk students not currently receiving counseling or therapy.
Since its official launch in 2006, the Interactive Screening Program, a tool originally developed as a research project, has been implemented at over 100 institutions of higher education, medical and professional degree schools, and has expanded to organizations and workplaces, including law enforcement agencies and Employee Assistance Programs (EAPs).
Through ISP, over 160,000 individuals have connected with a mental health professional. Of those, 70 percent indicated current suicidal thoughts, plans, or behaviors with over 73 percent not getting any type of counseling or therapy.
ISP stands as an uncommonly plain example of how when it comes to suicide prevention, the research we do, can – and often does – provide a direct path to more people finding support, and ultimately creating safer communities for all of us.
To learn more about AFSP’s Interactive Screening Program (ISP), click here.
For further information, or for copies of ISP publications, contact [email protected]
 American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2015. Hanover, MD: American College Health Association; 2015. Gallagher, Robert P. (2015) National Survey of College Counseling Centers 2014. Project Report. The International Association of Counseling Services (IACS).
 Van Voorhees, B.W., et al. (2005). Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults. Annals of Family Medicine, 3(38), 42–43.
 Zivin, K. et al. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66, 522-524.
 Mansfield, A.K, et al. (2005). Measurement of men’s help seeking: Development and evaluation of the barriers to help seeking scale. Psychology of Men & Masculinity, 6(95), 105.
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