b'will cause severe impairment, with the average onset of depression and dysthymia occurring between ages 11 and 14 years 9 ; therefore, school staff may play a pivotal role in recognizing and referring the student to treatment that may reduce risk and enhance overall performance and improve long-term outcomes. Though mental health conditions are a risk factor for suicide, the majority of people with mental health concerns do not engage in suicidal behavior.Youth Who Engage in Self-Harm or Have Attempted SuicideSuicide risk is significantly higher among those who engage in non-suicidal self-harm than among the general population. Whether or not they report suicidal intent, one study found that 70 percent of adolescents admittedinto inpatient psychiatric treatment who engage in self-harm report attempting suicide at least once in theirlife. 10Additionally, a previous suicide attempt is a known powerful risk factor for suicide death. One study foundthat as many as 88 percent of people who attempt suicide for the first time and are seen in the Emergency Department go on to attempt suicide again within two years. 11Many adolescents who attempt suicide do notreceive necessary follow-up care for many reasons, including limited access to resources (transportation, insurance, copays, parental consent, etc.).Youth in Out-of-Home Settings Youth involved in the juvenile justice or child welfare systems have a high prevalence of risk factors for suicide.As much as 60 to 70 percent of young people involved in the juvenile justice system meet criteria for at least one psychiatric disorder, and youth in juvenile justice residential programs are three times more likely to die by suicide than the general youth population. 12According to a study released in 2018, nearly a quarter of youth in foster care had a diagnosis of major depression in the last year. Additionally, a quarter of foster care youth reported attempting suicide by the time they were 17.5 years old. 13Youth Experiencing HomelessnessFor youth experiencing homelessness, the rate of self-injury, suicidal ideation, and suicide attempts is over two times greater than those of the adolescent population in general. 14These young people also have higher rates of mood disorders, conduct disorder, and post-traumatic stress disorder. One study found that more than half of runaway and homeless youth experience suicidal ideation. 15American Indian/Alaska Native (AI/AN) Youth In 2017, the rate of suicide among AI/AN youth ages 15-19 was over 1.6 times that of the general youth population. 16Risk factors that can affect this group include substance use, discrimination, lack of access to mental health care, and historical trauma. For more information about historical trauma and how it can affectAI/AN youth, see ihs.gov/suicideprevention.LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer or Questioning) YouthThe CDC finds that LGB youth are 4.5 times more likely, and questioning youth are over twice as likely to considerattempting suicide as their heterosexual peers. 17 One study found that 40 percent of transgender people attempted suicide sometime in their lifetimeof those who attempted, 73 percent made their first attempt before the age of 18. 18Suicidal behavior among LGBTQ youth can be related to experiences of discrimination, family rejection, harassment, bullying, violence, and victimization. For those youth with baseline risk for suicide(especially those with a mental health condition), these experiences can place them at increased risk. It is not their sexual orientation or gender identity that place LGBTQ youth at greater risk of suicidal behavior, but rather these societal and external factors: the way they are treated, shunned, abused, or neglected, in concert with other individual factors such as mental health history.Model School District Policy on Suicide Prevention | Model Language, Commentary, and Resources 19'