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Lethal Means and Adolescent Suicidal Risk: An Expansion of the PEACE Protocol

Suicide is one of the leading causes of death among adolescents. With rates of suicide among rural youth nearly double those of urban youth, suicide among adolescents in rural areas is a major public health concern. School mental health programs, which provide mental health services to students in the context of the school, address many barriers to accessing mental health treatment in rural areas and may include efforts to address suicide prevention. Of critical importance in suicide prevention strategies for schools are methods for restricting access to lethal means and methods for facilitating student referral for risk assessment and management. In addition, there is a need to develop effective suicide crisis response protocols appropriate for the school setting. The Prevention of Escalating Adolescent Crisis Events (PEACE) protocol was developed and revised to create a thorough risk assessment process for mental health clinicians working in tandem with school personnel in educational contexts. The PEACE protocol was utilized for 78 crisis events that involved 58 students during the 2016–2017 school year. During 2016–2017, the PEACE protocol was revised to collect more detailed information on how students were referred for assessment and to directly track how crisis response and safety plans addressed access to lethal means. These results and the clinical implications of utilizing this protocol and the assessment findings to address school-based suicide prevention efforts are discussed.