Campuses find success by taking suicide prevention efforts grounded in best practices and adapting them to best fit their students’ needs.
Interview by Deborah Taub
Suicide is a tragedy that can dramatically affect any college or university. Facing something that immense, campuses consider broad, cultural, comprehensive strategies to make a difference by improving access to mental health care, building economic stability, and fostering protective environments. They also explore more targeted programs, a cornerstone of which is often gatekeeper networks.
Campus gatekeepers are any individuals who may find themselves interacting with another who is considering suicide or self-harm. Typically, this label is applied to faculty, safety officers, and counselors – authority figures assumed to have the knowledge and gravitas to respond to such a traumatic event. Often, though, the initial gatekeeper is more likely to be a friend, roommate, family member, staff, or someone else who is closer – physically and possibly emotionally – to the student in crisis. What can be done to ensure that those individuals have the knowledge, skill, and experience to respond when they may have only one chance to get it right? This is where orchestrated educational efforts are most valuable in reinforcing those networks.
The names of these programs are familiar to most in psychology or student affairs. There is the Mental Health First Aid program, QPR (Question, Persuade, Refer) training, Safe Scenes, the Crisis Prevention Institute, and other evidence-based approaches. While these provide a solid foundation, research has increasingly shown – particularly within a higher education context – that the most effective strategies are tailored to a specific campus culture and structure. What qualities differentiate the students at ABC College from those at XYZ University? Who are students most likely to respond to? What resources are currently in place? How invested are campus leaders?
The Talking Stick brought together a panel of researchers and practitioners to discuss the different ways their campuses have assessed their own conditions and then worked to leverage existing programs, or create new ones, to empower their gatekeepers and reduce the likelihood of a suicide. Moderating the conversation is Deborah Taub, the chair of the Department of Higher Education and Student Affairs at Binghamton University, who has researched suicide prevention strategies throughout her career. Joining her is Kathy Cooney, associate director for Crisis Response and Operations at the University of California Santa Cruz (UCSC); Matthew Foster, executive director of housing and dining at Worcester Polytechnic Institute; Laura Lewis, assistant director of the Suicide Prevention Program at The Ohio State University; Jacey Mize, assistant director for Crown and Merrill colleges at UCSC; and Lynn Ontl, director of Beard Wellness Center at the State University of New York Cobleskill.
This conversation has been edited for length and clarity.
Hello, everyone. I’m looking forward to this conversation. I have done work in suicide prevention at institutions where I’ve previously worked and was the principal investigator for Garrett Lee Smith Campus Suicide Prevention grants at Purdue University and the University of North Carolina at Greensboro. The programs were very different from one another, and one of the things I have been particularly interested in is how suicide prevention programs need to fit a campus’s institutional setting, the student body, etc. To get us started, I’d like to hear what things you considered in terms of your program and how it fits with your institution. What did you ask yourself as you were setting up your programs?
Lynn Ontl: Over the past two years, we've taken the initiative to implement Mental Health First Aid training on our campus; we extended it to faculty and staff in year one, but in year two, we focused on student leaders. Our vice president and our director of housing agreed to make it part of the mandatory training for resident assistants (RAs), so we now have 90 RAs all trained in Mental Health First Aid. They get the certification, which they think is cool. We were fortunate to have seven trainers on our campus, only because we were selected for a grant, so it cost us nothing. As you probably all know, Mental Health First Aid training lasts a week, and it’s expensive. But that has been well received by our campus.
Looking at our work, we learned that we're good when something happens. We have crisis response down, and res life, university police, the wellness center, administration, and public relations all work well together. But what we wanted to focus on was the prevention work and early intervention. What has been interesting with the res life and wellness center partnership is how much the RAs appreciated the opportunity; they received training on Counseling 101, learned about signs and symptoms, and participated in QPR (Question, Persuade, and Refer) training. The RAs loved the skills and confidence that the training provided, but they wanted more on suicide intervention. Based on that feedback, we now have a three-pronged approach. Mental Health First Aid is one part of the suicide intervention, and that is in addition to QPR training for our res life leaders; the SUNY system has also developed its own homemade suicide prevention video. I was most struck by the fact that the students spoke up and said, “This is great, but the part that's most stressful, suicide intervention, we want to learn more about that.”
That is really cool that it was driven by student requests.
Jayce Mize: I've been working at UC Santa Cruz for about four years, and when we started with our student leader training, a lot of our conversation about mental health was driven mainly by our counseling and psychological services team. We did some skits or scenario-based training with our student leaders, but we got mixed reviews about how helpful or supportive they were. Either the students found that things were a little too explicit for what they wanted or sometimes not explicit enough.
We developed a mental health committee to push forward an initiative to get some of the staff QPR gatekeeper-certified. I'm one of those staff who took that training, got certified, and then provided it to about 70 student leaders whom I oversee. We have a total of 300+ student leaders, so it’s a small subset of that, but they found it extremely beneficial and appreciated that it covered more details about what they most wanted to know about suicide prevention and intervention. It provided them with some of the skill set needed to know what to look for, what to ask about, and how to maintain that line of not being an expert while still making sure that students are getting the support they need before referring them up to mental health professionals.
I have a clarifying question. When you say student leaders, who are you talking about?
Mize: I'm referring to our resident assistants, as well as our community programming assistants. RAs do kind of everything. CAs are our community assistants; they are very targeted to just programming for the larger student body.
Matthew Foster: I'm going to start by giving some context for our campus’s academic rigor because that lends itself to how we have to build our wellness and well-being initiatives. We are a four-term institution, so our students complete two seven-week terms in a semester. They are very compact classes, so while a typical class over a 14-week term might meet twice a week, our students may have those classes four days a week, with homework nightly. It's a very intensive program. We also have a model where the students are graded A, B, C, or “no record,” so that's a little different. Thinking about that culture, it's not just fast-paced for the academics; it's fast-paced for students outside the classroom, for us as staff, for counselors, and for the counseling center. One of the mantras on campus is that students are always three and a half weeks away from a midterm or a final.
We have worked for years to improve our resident advisor training by teaching them how to empathize and work with students before and throughout a crisis. In the last few years, our Center for Well-Being has been less of a counseling center and more of a proactive and preventative resource. We've implemented QPR training for our resident advisor staff and our professional staff across campus, including the entire student affairs division, faculty, and staff.
We also included peer ambassadors to work on things like tabling and events, because our students respond very well to peer-to-peer interactions and peer-to-peer support, more than they do from me, a professional staff member telling them what they should do or how to take care of themselves. We have also implemented wellness days in our schedule, so students can reset one day each term, and there are no classes, no exams, no homework.
What I call the student clock is very different there. The pressure points are in a different place than on other campuses.
Kathy Cooney: At UCSC, we have a new crisis response program with a team consisting of an assistant director and two coordinators. Our residential numbers are about 9,500 students, and our team will support all 10 residential colleges. The program was established by our associate vice chancellor, who wanted to create a program like this for a number of years. We are now in the right place and have the right resources that, with some restructuring, will allow us to start the program. My position was restructured specifically to build this program.
The program goal is to provide more seamless support to students who might be experiencing a crisis, such as suicidal ideation, and at the same time focus on prevention through our intervention efforts. We want to help our live-in staff respond to situations. There's so much on their plates already, and now our dedicated team can take some of that crisis response and intervention off their plates while a team of folks intervene with the student, support them through the crisis, and connect them to our different resources.
We also have an office called Slug Support (our mascot is a banana slug). It's a centralized office that triages and connects students with resources. Mostly the office deals with financial matters, but sometimes students who are struggling may also be experiencing suicidal ideation, so they can be cleared through that office while we continue working closely with them.
We also have a Mental Health First Aid program on our campus. I was first trained as an instructor around 2012, and then we required training for RAs until the pandemic, which had changed everything we did with our teaching, plus we lost some trained staff and eventually paused those efforts. But now our assistant director and I have just gone through our recertification training in the last two weeks. We are going to start requiring that for live-in staff, assistant directors, associate directors, and our programming professionals. I believe we will rethink and discuss requiring that of RAs as well because it did make a difference, as you all have said. Through this program, I think we're going to be able to connect and get into prevention work with our campus partners, even though that's not our primary focus.
Thank you. I have a follow-up question, but I want to hear from Laura first.
Laura Lewis: I was thinking about how I wanted to navigate this and weave together some of the things you all have said. So, Ohio State is huge, right? We have 66,000 students that we're serving. Our program is a standalone program adjacent to the counseling center, so we're good neighbors. We were funded by the Garrett Lee Smith grant back in 2006 and actually funded it again in 2009. Over the years, we've grown into a fully operational staff of 10, running a number of initiatives across campus, one of which is certainly education, including our suicide prevention gatekeeper trainings. But being 100% in the prevention space, the three buckets that we really live in are education, advocacy, and outreach. We also partner on campus, off campus, and around the state of Ohio in many prevention initiatives. We have partners on campus in the intervention space, and in the event of a tragedy (the postvention piece), we can help guide people in that arena.
Back when we first received our grant, we used QPR. This is predating me, but we realized – and I say “we” collectively – that some things about QPR were missing. We felt we could contribute, so we stopped QPR, lost the founder of the program at that time, wrote our own curriculum for gatekeeper training that falls in line with best practices, and included a lot of things you all would expect to see. The name of that program is REACH, and we've been using it ever since.
We offer this program across all our campuses. We use a peer-to-peer model for that and, of course, update the curriculum every year. When undergraduate students are training and certifying fellow undergraduate students, it's a very different experience from when a staff member like me does it. We have two pools of trainers. Undergrads apply, we interview them, we select them, and they spend an entire semester learning how to facilitate this 90-minute in-person training. While the newbies are learning it, the returners are picking up the slack and leading many of the other training sessions across campus. And then, come January, everybody's on the same page.
All of this is a heck of a commitment, and I have a graduate teaching assistant who is specifically responsible for that program. Undergrads train undergrads, and then we have a whole separate group of 55 trainers who are staff, faculty, graduate students, and professional student trainers, and they specifically train staff, faculty, grad, and professional students. So the peer-to-peer model isn't just for undergrads; it's for everybody. There are moments when we will pair a staff trainer with a student to deliver the training, depending on the request and the audience. For example, they might have higher-level questions and want to have someone with a mental health background in there, so we're very strategic about that. But we're doing these trainings every week, all over campus. People can request them, and we take the show on the road. Or, every month, we offer multiple sessions that people can sign up to attend on their own. We have a full-time person on our staff just responsible for that.
This past fall, we launched Reach 2.0, which is a booster session. We're at 35,000 people who have gone through REACH at Ohio State, and if they want to brush up their skills or go a little deeper, they can sign up for this 60-minute in-person experience, which involves a case study and a lot of interaction, just to keep those skills fresh.
We have trained our RAs for many years, but the addition of 2.0 allows our returning RAs to go through something different. We did that in August for the first time this past year, and it was well received because, historically, they would just be going through REACH over and over again. That isn't terrible, but if they've been an RA for three years, they're looking for something more. As you all have said, there's definitely a hunger out there to do more in the suicide prevention space. We have about 400 RAs who go through either REACH or REACH 2.0.
Our undergraduate REACH trainers are also involved in advocacy and outreach efforts and professional leadership development. We show them how to implement comprehensive suicide prevention on a college or university campus and have an internship program for undergraduate students. I take two in the fall and two in the spring of every year, and they're getting a good behind-the-scenes look at what prevention is all about. I think it’s a great opportunity.
I'm interested in the peer-to-peer piece, and I'm thinking particularly about RAs. We ask a lot of RAs, so I’d like to talk about why they are particularly important as gatekeepers and then move on to how we can best prepare them for this heavy part of their role.
Lewis: It’s a best practice and part of training anyway, but I think it's worth underscoring that the training is largely about the role play: having them practice saying things that are uncomfortable and difficult to say or teach them how to ask directly about suicide. Videos and lectures can go a long way. There's a place for that. But what I find, and what our data on REACH suggests, is that one of the most important things we do is role play. Our RAs are no different.
I think they appreciate sitting in a non-judgmental space and being able to try out language they might not use in other circumstances. And the data's clear: The more we do role plays, the greater the odds that students will actually use those skills when they need to. And we say “When they need to,” because we know they will. We say to our RAs, “You will need to do this if you haven't already. So just assume that this is going to be an opportunity for you to help someone.”
Even though our REACH training is standard for everyone we train at Ohio State, we nuance it a little for RAs to make language reflect the things they experience in our residence halls. It lets them see that this is tough, but we also know they can do it, so we're going to keep chipping away at it and trying to build the competence, confidence, and willingness that they need.
Let's hop back to the Santa Cruz folks. Why is it particularly important that we train RAs, and how do we best prepare them for this part of their role?
Mize: The best response is that they live where they work. They are among these students all the time. They're the ones who are having conversations, noticing certain behaviors, and responding to calls from roommates or concerned friends. Sometimes the campus police call professional staff if a family member calls, but for the most part RAs are the ones who are on the ground, seeing it firsthand.
A big part of conversations with our RAs is emphasizing that though they are in a position to notice something first, that doesn’t mean they are expected to be the mental health expert. It's the RA who will start the conversation with them and then get them to the expert. We teach them how to get the student to verbalize what they're thinking or feeling, so the RA can call a mental health professional and describe the situation. We try to emphasize that they aren’t expected to be a mental health counselor.
That's why it's important to train them to notice the signs and concerns, know what to do with that information, and know how to talk about it with the student in a way that makes it less intimidating to say “It's okay that you feel this way, but we want to get you the help that you need to know that suicide is not the option.”
Ontl: In my 26 years, I have seen RAs save lives. It was thanks to their interventions that students got the help they needed. I'm not sure I can even speak to the depth of how important it is that they have these skills and are able to use them. That's why we use a multi-layered approach to train our RAs. Even as a professional counselor for many years, I still don't feel at ease when I have to talk to somebody and ask if they are thinking of killing themselves. I know that teammates have helped other students and that floor mates and club members can lean on each other. But, in all these years, I always say that RAs occupy the most important leadership position on this campus, because I've seen them save lives.
When it comes to the suicide prevention skills training, I can see them roll their eyes, “Oh, it’s role playing again.” But we conduct these sessions as part of our training, and they also do the classic Behind Closed Doors at the end. The wellness center staff handle the ones about suicide intervention because it is so important that the RA is not saying, “Are you thinking of killing yourself?” in front of a student for the first time. We want them to have spoken those words aloud multiple times before they face the real deal. I think we're all on the same page with how important that is.
On a personal note, when my first son went to college, I told him I thought he could be an RA. He had the best experience because, let's face it, our RAs leave with better leadership skills than students in other leadership positions on this campus. They get all the training and are in real-life situations every day, solving problems, making referrals, building resources, and conducting programming. There's no other position on a campus that gives a student that much real-life experience.
Thank you, Lynn. I know we're in the same SUNY system, but I don’t know a lot about the Cobleskill campus. Are there things about your students or the culture there that you needed to think about in terms of how you organized or what you included in your training?
Ontl: We are an ag and tech college, and many of our students come from families who are farmers or in the tech world. They’re not coming to us willing to talk a lot about their feelings and tell us exactly what's wrong, so it's important that we encourage the conversation, whether it's with faculty and staff or our student leaders. While some of our students are very willing to be open books, we do have a large population that at least have to be met halfway before they'll open up and receive help.
Also, we're a small campus, so people get to know the students well, and students get to know the faculty and staff well. It was the faculty and staff who were intimidated at the start by these conversations, so that's why we started the Mental Health First Aid training for them. Now, every one of our coaches is trained, and that was mandated by our athletics director. We’re also working on having all the captains of the athletic teams be trained in the Mental Health First Aid program.
I said I had a follow-up for Santa Cruz. You mentioned your residential college system, and I'm wondering how that influences or plays into what you do for prevention efforts.
Cooney: Sure. We're kind of modeled after Oxford and have 10 residential colleges, with smaller communities within the larger 19,000-student campus. Each of our residential colleges has a theme. It's not major-specific, but there's a theme related to the college, and first-year students must take a course that ties into that theme.
Historically, the 10 colleges were independent of each other, so teams were hired independently, the students stayed within the college, and they didn't necessarily venture out to other colleges. It was very much like little independent campuses. Then over the years, that shifted and changed. Now we have students who are affiliated with colleges living in different locations. We’ve collaborated on our hiring processes, so we can have one consistent hiring process for all our student leaders. The training is done collaboratively. I think it was 2020 when we started doing things in a more centralized way. That helps us bring more consistent practice and support to the students, especially with training. Before, we trained our own staff based on the needs of the community, and now we're making sure there's a consistent foundation of training at each of the colleges.
It also means that student staff are building relationships across the units: When I'm an RA in one college, but I visit my friends in another college, I'm not taking my RA hat off. When I see a concern, I know who I can reach out to at the other college. I think there's more seamlessness of services and support for our student staff and our professional staff.
I grew up about an hour and a half from Columbus, and one of the things I think about Ohio State is the size of the main campus. And you have some very large residence halls on that campus. Was the size of the campus a consideration to you as you developed the REACH program and REACH 2.0?
Lewis: For us, it was about the flexibility to teach in ways that would work for a large number of people. The pandemic taught us what we could do. REACH will never not be done in person; that will always be the best, safest experience we can give people. But REACH 2.0 was conceptualized to eventually be offered virtually.
We think a lot about what could be called the pockets of our campus because we have so many residence halls, and only two of our regional campuses have them. There’s that, but there's also the flexibility of being able to get to as many people as we can, and it doesn’t always have to be in person. For those of you who have regional campuses, you probably know that each campus tends to have its own culture and identity, so sometimes trying to unify what happens across campuses can be challenging. They can also feel forgotten or less than, like they're not getting the same attention or resources as everybody else. I feel like our ability to conduct training sessions on our regional campuses and to be able to include students and residents is going to get better because we're going to have a virtual option. So, to answer your question, size is a consideration, but so is flexibility for learning and trying to figure out the best way that we can deliver this information to as many people as we can.
To wrap up, I’d like to hear a lesson learned or a recommendation for others that you could share.
Foster: My department is in the process of making a drastic change in the structure of our student staff, and Binghamton actually was an influence there. Our student staff has unionized in the last two years, so we are now working under a collective bargaining agreement. In terms of our student staff taking care of their residents, I have rarely in my 20 years in the field examined the burden of being one person in a residence hall. It's a lot of work, right? It's a lot for them to do the programming and the check-ins and the crisis and all those things. So we're actually flipping our model and splitting the role into three different positions. We will have programmers (who don’t necessarily live in the halls they work in) and community support assistants who will be on-call duty crisis responders.
I’m most excited about our residential mentor position, which will be part of the student concern team. They will have one-on-one conversations (we call them Gompei Chats, after our mascot Gompei the Goat) with individual students or with an entire room. They will talk to them, chat with them, and notice if someone is a little down or not as energetic as they usually are. Then they can plan a follow-up and refer them to resources if needed. They will also be there if the behavioral intervention team hears from a student asking the mentor to reach out and do a quick check-in on someone.
The goal is to divide responsibilities and create those three focus areas for their work, rather than asking someone who just ran three programs that week and dealt with a crisis the previous night to check in with a student who might be thinking about killing themselves. They are not going to have the headspace to do that and may try to rush the conversation just to get through it.
My recommendation is to think about the student population and consider what's going to fit your campus’s needs. If it’s not out there, consider building it yourself. For example, we have a student support network that sounds a little similar to the REACH program (I don't want to compare it exactly), but it's built for our campus and offers five hours of training in peer support.
Can you spend a minute talking to me about your campus culture?
Foster: Our students are highly driven and focused on STEM fields like engineering, science, and math. A lot of our students were top of their class in high school, and when they get here, they are parallel with everyone else at WPI. It can feel competitive, but we are a very team-based institution and do a lot of project-based learning, which means that we all work together, rather than competing, and students interact with one another regularly. We spend a lot of time talking about how it's okay to fail and that you should just get up and keep moving. The campus motto is “theory and practice,” which I use in a conversation at least once a week: “You didn't do well with that, but pick yourself back up.” Theory and practice, trial and error. The light bulb wasn't invented the first time, you know. We need to educate them and work on that.
Cooney: The lesson learned from my crisis response program, since we're still in development stages, is that partnerships are very important. Campus partners are the most valuable resources we have, but it’s important to maintain clear lines of communication and to explain limitations or the terms of protocols when you tap into that partner. Our work, in particular, is not meant to take the place of counseling services or the crisis management team, which is interventionist. It’s important to be clear about our scope, our lane, what everybody else's is, and where we collaborate and overlap.
Lewis: I was going to say partnerships as well. I think they are the eyes and ears of our campus, and they know what spots we need to get to that we're not in. They’re also advocates for us, and it's a two-way street in that regard. The partnership model is key, and Kathy said that really well.
It’s important to remember to use student voices to guide initiatives, with good guardrails. Students have to have a stake in what we're doing to promote the message that suicide is preventable, but not everybody knows how to get the message across, how to do it safely, and how to do it well. It's imperative that students have a say in how we go about this. It's a big miss when we forget about them.
Mize: My mind was also going to campus partners or resources. Earlier, we highlighted the fact that RAs do a lot, so we need to remember that the programs, interventions, and trainings can only be as strong as the experts who serve the students. We can handle these crisis intervention pieces, but if we don't have the staffing in our counseling and psychological services or if we don’t have the staff for campus mobile crisis response and other experts to back up the learning, it can be difficult to say “We care about you, and we care about suicide intervention.”
We recognize that we're seeing more mental health crises than ever before, and more students are open to talking about it. But we are still understaffed in some important areas across campuses. A lot of our efforts go towards building those teams up and making sure we're accurately reporting the number of crises we're seeing so that staff get the push that they need to be funded and to hire in those positions as well.
Ontl: We always start RA training – and I can't say it enough – by saying that now that they are an RA, self-care is not an option. It's got to be a priority because of the position that they are in. Another student might be able to not get enough sleep, not get enough downtime, and stay up all night, or overdo it in the party scene. But as an RA, their self-care has to be a priority. It has been helpful to them to have that validated from the very beginning. In order to be on in a good way, you have to be off sometimes, and to take yourself off.
Finally, I don't know if you all are seeing it, but we are seeing an increase in students on the spectrum coming to our campus. With that, you also see a lot of comorbidity with mental health issues, and transition issues trigger mental health issues. That has raised the bar for us to increase our training efforts with student leaders. Again, as we've been saying from the first part of this conversation, they are the ones who will see this first and experience it first.
Deborah Taub is a professor and the chair of the Department of Higher Education and Student Affairs at Binghamton University in New York. She is a past recipient of the ACUHO-I Research and Publication Award as well as the Betty L. Harrah Journal Manuscript of the Year Award.
