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The Effectiveness of a Systems Approach: Suicide Prevention on College Campuses
Mercedes Tate-Bierman
Counseling and Higher Education, Eastern Illinois University
CHE 5500
Dr. Tadlock-Marlo
December 4, 2020
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The Effectiveness of a Systems Approach: Suicide Prevention on College Campuses
Almost 800,000 individuals die a year from suicide, which equates to one person every
40 seconds (World Health Organization, 2019). Of those suicides, approximately 1,100 of those
people are college students, which makes it the second leading cause of death among college
students in the United States (Wilcox et al., 2010). With this growing number, it is essential for
therapists on college campuses to have adequate training and knowledge of best practices in
order to understand how to detect a high-risk individual and implement a plan of action to ensure
their safety. Through evidence-based interventions, it is promising that the likelihood of suicide
attempts can decrease.
The National Action Alliance for Suicide Prevention (2011) created 14 different task
forces to aid in suicide prevention at the national level in the United States. More specifically,
one of the task forces created was the Clinical Care and Intervention Task Force, which helps to
guide mental health professionals working with suicidal clients through a systems approach
(National Action Alliance, 2011). This task force created a document, Suicide Care in Systems
Framework, pointing out that a systems approach is most effective in clinical suicide prevention
(National Action Alliance, 2011). Through this framework, the task force suggests that suicide
risk should be screened and assessed, followed, and treated using evidence-based interventions
while the suicidal patient is in the care of mental health professionals (National Action Alliance,
2011). By implementing the systems approach in healthcare facilities on college campuses, the
number of college student suicides will decline.
Literature Review
The Clinical Care and Intervention task force created Zero Suicide, which takes several
initiatives to reduce suicide by using a systems approach (National Action Alliance [NAA],
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2011). Zero Suicide has been implemented in a large number of organizations (NAA, 2011).
This program indicates that using a systems framework in mental health facilities reduces the
amount of suicides (NAA, 2011). A systems framework recognizes that genetic constraints,
developmental trajectories, and life contexts are interrelated (Tramonti et al., 2019). On college
campuses, it has been found that college students are hesitant to seek mental health treatment
(Canto et al., 2017). Professionals are aware of the needed change in college mental health
services, but students report that following a plan of action would be helpful to get them though
mental health struggles (Brownson et al., 2016).
Zero Suicide
Zero Suicide is a suicide prevention approach that was created by the Clinical Care and
Intervention task force (NAA, 2011). The task force reports a high success rate by taking several
initiatives, but three critical factors are highlighted. The first factor is the core values:
highlighting the idea that suicide can be completely preventable while an individual is under the
care of a mental health professional by improving service access, providing quality care, and
giving opportunities for continuous development (NAA, 2011). Another aspect of the critical
factors is systems management, where systematic steps are taken to set achievable goals to
eradicate suicide attempts and deaths and offer support to clients to create a culture that does not
deem suicide as an acceptable way out (NAA, 2011). Lastly, using an evidence-based clinical
care practice, such as standardized risk stratification and targeted evidence-based clinical
interventions, among other practices, has indicated positive outcomes (NAA, 2011; Walters,
2019).
Today, more than 200 organizations are applying Zero Suicide in their healthcare settings
(Baker et al., 2018). Organizations are invited to join the Zero Suicide Community and given a
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ten-step guide to aid them in their execution of the model (Baker et al., 2018). The guideline
provides tools, such as forming an implementation team, using the Zero Suicide Toolkit, and
establishing an evaluation plan (Baker et al., 2018). All clients are screened for suicide risk
within each contact, and when a positive screen arises, a complete risk assessment and protocol
for treatment planning is developed for the individual (Walters, 2019).
Preliminary data indicates promising results for the Zero Suicide program. Many
organizations that have already implemented this program have seen a drastic decrease in suicide
rates among clients (Hampton, 2010; Hogan & Goldstein, 2016). Implementing a systems
approach in university healthcare facilities, like Zero Suicide, would provide counselors with the
tools that they need to properly assess and treat students who are at risk for suicide, therefore,
reducing students’ successful completion of suicide.
Systems Perspective
Ludwig von Bertalanffy introduced the General Systems Theory (GST) in the twentieth
century (Tramonti et al., 2019). His framework viewed how biological, psychosocial, and social
dilemmas are causally intertwined (Katrakazas et al., 2020; Tramonti et al., 2019). The
biopsychosocial approach in this theory points out the connection between genetic constraints,
developmental trajectories, and life contexts (Tramonti et al., 2019). Currently, reductionist
theories dominate interpretations of biological and psychological processes. These theories do
not recognize the complexity of developmental processes (Tramonti et al., 2019). Instead,
Bertalanffy saw the importance of considering them as parts of larger wholes and approaching
them trans-disciplinarily as intertwining relationships (Tramonti et al., 2019).
Current Mental Health Service Concerns on College Campuses
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Although college campuses do have mental health services, there are some clear issues
aiding in the suicides among college students. Despite mental health treatment being offered,
access to health insurance appears to directly correlate with the likelihood of an individual to
seek treatment (Dunley & Papadopulos, 2019). Many large universities offer discounted services,
but with long wait-lists (Dunley & Papadopulos, 2019). Because of limited on-campus resources,
students are often referred to off-campus services (Dunley & Papadopulos, 2019). Many plans
are capped at $300 per year, while just a single visit can exceed $100. Plans with limited
coverage may cover only 20% or less of an appointment (Dunley & Papadopulos, 2019; Jackson,
2016).
A number of improvements need to be made to college mental health services (Riba,
2001). Some of these suggestions include consulting with campus partners, case management,
and working with departments of psychiatry and outside hospitals (Riba, 2011). Unsupportive
campus environments also account for resistance to mental health treatment and increased mental
health issues (Kelly, 2001). Having a greater sensitivity for student’s needs must be considered
by not only mental health professionals, but by the entire university staff (Kelly, 2001).
Students seem to not share their thoughts for fear of stigmatization, not believing others
can help, thinking their thoughts can just go away, and not wanting to be a burden to others
(Canto et al., 2017). A portion of students are mandated by campus staff to obtain mental health
treatment, showing policies to identify students at-risk may be beneficial to aid students in
obtaining treatment (Downs & Eisenberg, 2012). Undergraduate students report that making a
plan to get them through mental health battles, organizing tasks, thinking the tasks through, and
promoting exercise would be useful strategies (Brownson et al., 2016). The tough demands of
managing thousands of college students make it difficult for counselors to provide effective
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treatment for at risk students. Using a systems framework would allow healthcare providers to
identify students who are at risk and provide life-saving treatment.
Problem Statement
A systems approach to suicide is indicated as successful for other organizations
(Hampton, 2010; Hogan & Goldstein, 2016). More so, college students believe making a plan of
action would be beneficial to their mental health (Brownson et al., 2016). Therefore, this
research asks; would implementing a systems approach in healthcare facilities on college
campuses reduce the number of student suicides? This research is necessary to identify the
effectiveness of a systems approach by healthcare providers on college campuses in order to save
the lives of college students.
Conclusion
Using a systems framework, the Clinical Care and Intervention task force created Zero
Suicide, which uses several intervention tactics in order to reduce suicide (NAA, 2011). Zero
Suicide has been implemented in hundreds of organizations and shows a promising result that
using a systems framework is effective in intervention and treatment for individuals who are at
risk for suicide (NAA, 2011). A systems framework acknowledges the interconnectedness of
genetic constraints, developmental trajectories, and life contexts (Tramonti et al., 2019).
Professionals are aware that change is needed in mental healthcare facilities on college
campuses, with students highlighting that a plan of action would greatly assist them (Brownson
et al., 2016). Based on the proven effectiveness of a systems framework in other organizations,
professionals recognizing change is needed, and students reporting that a plan of action would be
beneficial, implementing a systems framework in college mental health facilities will reduce the
number of suicides among college students.
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Method
A quasi-experimental methodology was chosen to investigate the effectiveness of using a
systems approach in healthcare facilities on college campuses in order to decrease suicides
among college students. The alternative hypothesis of this study was that implementing a
systems approach in healthcare facilities on college campuses would result in fewer suicides of
college students. The purpose of this research was to provide college mental health counselors
with an intervention that would be successful in reducing suicides among college students.
Participants
All counselors at a college university were solicited for participation upon the approval of
the university’s institutional review board. All 20 counselors who were solicited responded, and
they were provided with an informed consent highlighting the scope and limitations of the study.
Once the informed consent was completed, counselors were given more information about the
study and guidelines for participation were discussed.
Procedure
Participants were enrolled in a three-part webinar course on using a systems theory in
practice through the Midwest PBIS Network (n.d.). Upon completion of the webinar course,
participants were instructed to begin implementing a systems framework in their practice. The
participants met once weekly to review their practices of the systems framework over the first
year. Over the next four years, participants met monthly to review their use of a systems
framework in practice. Data was collected from the last five years of the university’s student
suicide rate based on reported suicides from the university. Data was also collected each year
following the implementation of the systems framework. Through this longitudinal study, a
paired samples t-test was used to analyze mean differences in suicide rates in college students
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after the implementation of a systems perspective. Data was entered into IBM SPSS for analysis,
and a paired sample t-test was used to assess for significance at alpha = .05.
Results
This study followed a pretest-posttest design. Suicide rates among a university were
collected before and after the intervention with the implementation of a systems approach. A
paired samples t-test was conducted to examine differences in suicide rates between using a
systems approach in college mental health facilities and not using a systems approach in college
mental health facilities. Equal variance was assumed because the significance of 0.657 shown in
Levene’s test for equality of variance was greater than 0.05. There was a statistically significant
difference noted between the preintervention and postintervention. Suicide rates do differ based
on the use of a systems approach by professionals in a mental health facility (x = 2.383, sd =
1.13) or not utilizing a systems approach (x = 25.492, sd = 1.13); t(8) = 4.92, p = .005. These
results suggest there are lower suicide rates when a systems approach is implemented in a
college mental health facility. Specifically, the results suggest that the implementation of a
systems approach in college mental health facilities does reduce the number of suicides of
college students.
Discussion
The constructed quasi-experiment provides a framework for exploring the use of a
systems framework in college mental health facilities. The findings presented in this study
provide support for using a systems framework in mental health facilities in order to reduce
suicide rates on college campuses. The theme within this study, implementing a systems theory
in college mental health facilities, was congruent with other research related to counselors using
a systems framework in practice in order to reduce suicide (Hampton, 2010; Hogan & Goldstein,
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2016). Innovative methods of intervention can be initiated and researched as counselors become
aware of the process of using a systems framework in practice to prevent suicides. With this
information, counselors should consider their own ways of practice and consider adopting a
systems approach when working with clients. They should look into further research of using a
systems approach and focus on using scientifically proven techniques in their practice. Although
having an entire center use this approach would be ideal, counselors can also explore this method
of counseling themselves by enrolling in specific classes and bringing it into the center
themselves. Overall, client wellness and healing should be the focal point of counseling, and the
systems approach has shown promising results to support this (Hampton, 2010; Hogan &
Goldstein, 2016). This perspective aids in reducing suicide rates because it screens and assesses,
follows, and treats clients using evidence-based interventions while the suicidal patient is in the
care of mental health professionals (National Action Alliance, 2011). Having these evidencebased interventions in place ensures that no client slips through the cracks during treatment.
Limitations
Although the presented study was revealing about the benefits of using a systems
framework in practice to reduce suicides on college campuses, there were limitations. Due to
some students already seeking counseling at the counseling center when the study began, it is
unknown if the work already done with a student experiencing suicidal thoughts had an effect on
the outcome. Additionally, this study only focused on one university, so the sample size was
rather small and cannot be generalized to all universities. Another potential limitation was that
despite having check-ins with counselors to review their use of a systems framework in practice,
there was no review of the actual sessions. This element could have multiple effects; for
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example, the counselor could revert back to old techniques of practice in the sessions but ensure
in the meetings that they are using a systems framework.
Future Research
Future research could expand on the role a systems framework has in counseling. Most
research has been done in regards to using a systems framework in order to reduce suicides.
However, it would be interesting to see how a systems framework can be applied more generally
to be utilized in a variety of mental health issues presented in counseling. Qualitative research
could investigate the experiences of individuals who receive counseling using a systems
framework and the effectiveness this type of intervention has on individuals. Further research
could also examine the sustainability of the mental health of people who are counseled using a
systems framework.
Conclusion
Counselors at college mental health facilities are in a unique position to help students
through mental health crises. It is important for counselors to continually look for creative ways
to aid students in their mental health struggles so that they can be successful academically. Using
a systems framework in counseling is an effective way to reduce the number of suicides on
college campuses (Hampton, 2010; Hogan & Goldstein, 2016). The quasi-experiment developed
in this study highlighted that suicide rates in college students dramatically reduces when a
systems perspective is in place. Using a systems framework in mental health facilities on college
campuses is an innovative way to reduce the rate of suicides of college students.
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