Surveys Say We Need Legal Action: Addressing NYC’s Adolescent Mental Health Crisis

I. Introduction 

Recent Youth Risk Behavior Survey data reveals an alarming trend among New York City (NYC) high school students: rates of suicidal ideation and suicide attempts are rising considerably and surpassing national averages. From 2021 to 2023, the percentage of NYC high school students who “seriously considered attempting suicide” increased by 2.3%. The 2023 percentage of high school students who “actually attempted suicide” was significantly higher in NYC (12.6%) than the national average (9.5%), with NYC experiencing a 4.4% increase from 2021, even as the national rate declined by 0.7% during the same period. In addition, suicide attempts by NYC high school students were far more likely to result in “an injury, poisoning, or overdose that had to be treated by a doctor or nurse,” increasing 4.6% from 2021 to 2023 and reaching 7.1% compared to 2.3% nationwide.

Despite clear urgency, existing laws on the city, state, and federal level (such as the Garrett Lee Smith Memorial Reauthorization Act and NYS Assembly Bill A7762A) fail to adequately address this escalating mental health crisis among adolescents. Therefore, the New York City Council should pass a law that mandates (1) all NYC schools conduct annual school-specific mental health surveys and (2) most at-risk schools offer school-based family therapy programs.

II. Background

The Youth Risk Behavior Survey (YRBS) is a national school-based survey run by the Centers for Disease Control and Prevention (CDC), which collects surveillance data on the health-related behaviors of American youth. The YRBS focuses on seven categories of health risk behavior: (1) unintentional injuries and violence, (2) tobacco use, (3) alcohol and other drug use, (4) sexual behaviors, (5) dietary behaviors, (6) physical activity, and (7) obesity and weight control. Among these, suicidal ideation, planning, and attempts all fall under the first category. The YRBS is administered in randomly selected public and private high schools across the country and is anonymous, voluntary, and self-administered. The YRBS provides reliable insights into adolescent health risks and trends, identifying at-risk groups, and helping policymakers and public health officials implement targeted policies and programs. While YRBS data can help identify broad trends, they lack school-specific insights, without which, policymakers struggle to tailor interventions based on local needs.

III. Legal Gaps

A. The Garrett Lee Smith Memorial Acts

The 2004 Garrett Lee Smith (GLS) Memorial Act allowed the federal government to confer grants to states and institutions that provide youth suicide prevention support, particularly through early intervention, training, and data collection. The 2022 GLS Memorial Reauthorization Act increased annual federal funding to $71 million and furthered the emphasis on culturally responsive early intervention. While the 2022 GLS Act supports voluntary prevention efforts, it does not mandate consistent implementation at the state or local level. This leaves cities like NYC without enforceable, school-specific mechanisms to address rising suicide rates In addition, studies show that the GLS Acts have not been successful in reducing suicide rates. Instead, these acts have had negative effects such as stigmatization, violated privacy, and removal of social support structures. 

B. STANDUP Act

The STANDUP Act of 2021 requires state and local educational agencies receiving certain federal grants to implement evidence-based suicide awareness and prevention training programs for middle and high school students. Like the GLS Acts, this act does not require adoption so schools can opt out simply by declining the associated grant, which results in inconsistent implementation across school districts. Also, by focusing on awareness programs, this act places a disproportionate burden on students; after learning about awareness, they are expected to recognize signs of risk in themselves or others and seek help independently, a task that is unrealistic for many adolescents. Moreover, awareness programs do not provide schools, districts, or cities with data on the prevalence of suicidal ideation or attempts, thereby limiting their ability to understand the extent of the problem.

C. NYS Student Suicide Prevention Act

The New York State Student Suicide Prevention Act requires New York State high schools to develop and adopt policies on suicide prevention and intervention. These policies must include procedures for identifying at-risk students, provide access to appropriate mental health services, and support students and staff after a suicide incident. However, since each school district must create its own suicide prevention policies, this can lead to inconsistent standards across the state and gaps in support. In addition, no enforcement mechanism is in place, which disincentivizes school districts from completely complying with the standards put forth in this act.

D. NYC Chancellor’s Regulation A-755: Suicide Prevention/Intervention

Issued in 2024, NYC Chancellor’s Regulation A-755 outlines suicide prevention and intervention protocols for NYC public schools. It stated that each school must designate a staff member as a Suicide Prevention Liaison (SPL). The SPL is required to receive annual training “addressing risk assessment, crisis intervention, and the DOE’s notification and reporting protocols.” While the regulation provides a framework for school-level planning and response, it lacks enforcement mechanisms and does not provide schools with funding for these measures. As a result, implementation can be inconsistent across schools, particularly in under-staffed and under-funded school districts.

IV. Recommendations and Implementation

A. Annual Mental Health Surveys

In response to alarming youth mental health trends, the NYC Council should fund and require individual NYC public high schools to conduct anonymous annual mental health surveys. The Council possesses legislative authority over education policy, budget allocation, and Department of Education oversight.

Anonymous annual mental health surveys would generate targeted, school-specific information, enabling policymakers and school officials to identify site-specific risk factors and implement timely, localized interventions. Such surveys should aim to uncover contributing factors (such as bullying, anxiety, and external stressors like abuse or poverty) that may correlate with elevated rates of suicidal ideation or attempts. Understanding the impact of factors like these on a school-specific basis will allow school faculty and the NYC Council to develop and individually track targeted approaches for each school or district. Furthermore, the consistent use of such surveys may foster a culture of openness and trust, signaling to students that their mental health is a valued institutional priority. This may encourage students to come forward with individual concerns, thereby allowing for more targeted interventions.

To encourage action from the NYC Council, it is necessary to identify those specific council committees best suited for these school-specific surveys. The most important committees to identify are (1) Education, (2) Children and Youth, (3) Health, and (4) Mental Health, Disabilities, and Addiction. Since these committees oversee and propose policies related to schools, student well-being, public health, and mental health services, they can take initiatives to address adolescent suicide prevention in NYC schools. Next, it is essential that council members recognize this public health crisis as requiring urgent action. To do so, YRBS data should be presented to show that the NYC high school suicide rate exceeds the national average and continues to increase while the national trend declines. Additionally, comparing NYC data (suicide attempt rate of 12.6%) with statistics from other major cities like Chicago (suicide attempt rate of 7.3%) can further support the need for local policy interventions.

Existing YRBS survey collection lacks school-specific data. Annual school-specific surveys would fill this gap by identifying high-risk schools and ensuring targeted interventions. To strengthen the council’s support further, it is important to emphasize that such early intervention financially benefits the city. Research from the National Research Council and Institute of Medicine shows that for every one dollar invested in prevention or early intervention for mental illness, cities can expect two to ten dollars in long-term savings in healthcare, criminal justice, and education costs. Therefore, with the school-specific survey data, the city can address this crisis, improve student well being, and reduce the financial burden on other public systems.

B. School-based Family Therapy Programs

Another action the NYC Council should consider is providing fully funded, school-based family and group therapy programs in high-risk schools, districts, and communities. Existing school-based mental health programs focus mainly on individual students without considering their family environments, which can play a significant role in suicide prevention. Some risk factors for adolescent suicide include “a family history of suicide attempts” or family conflicts. Family or group therapy may best address these risk factors, but families facing these issues may struggle to access or afford such therapy. Research supports the success of family-based crisis intervention. The American Academy of Pediatrics has reported that such interventions help stabilize adolescents with suicidal ideation, often preventing hospitalization. To fill this gap, the NYC Council should implement school-based family and group therapy teams in high-risk schools. These mental health teams should offer free, in-school family counseling, making it easier for students and their families to get help in a more accessible and familiar environment. The mental health teams should include representative providers who consider factors like culture and spoken language in overcoming barriers. This approach can also include family workshops on suicide prevention and youth mental health.

A similar approach has been adopted in Sacramento County, California, where a government-funded school-based mental health program aims to turn schools into “centers of wellness by placing mental health teams in every school across the county” to support both students and their families. The NYC Council could replicate this model by launching a pilot family therapy program in the highest-risk NYC public schools and tracking student and family outcomes to measure its effectiveness.

C. Challenges and Ethical Considerations

While these recommendations offer necessary steps toward addressing NYC’s adolescent suicide crisis, there are challenges and ethical concerns that governments and policymakers must consider. First, schools must ensure that the annual mental health surveys protect student privacy and comply with the Family Educational Rights and Privacy Act (FERPA). Second, school-based mental health programs that involve families can raise concerns about consent and accessibility. Some families may be hesitant to participate due to stigma, language barriers, or distrust of public institutions. It will be important to design these programs with cultural sensitivity and provide materials in multiple languages to ensure that families understand their purpose and feel supported, not judged. Lastly, implementation will not look the same across all schools. Under-resourced schools may struggle to carry out surveys or sustain therapy programs without clear funding and support from the city. For these initiatives to succeed, the NYC Council must pair any mandate with the funding and oversight needed to make sure every school can follow through.

V. Conclusion

Overall, rising suicidal ideation and attempt rates among New York City high school students highlight an urgent need for more effective interventions. To address this issue, the NYC Council should mandate annual school-specific mental health surveys and expand school-based family therapy programs in high-risk districts, ensuring that mental health resources are available to those who need them most. By modernizing data collection and expanding school-based support, New York City can create a more proactive and responsive system that prioritizes adolescent mental health and helps prevent future tragedies.

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1  “High School Students Who Seriously Considered Attempting Suicide.” Centers for Disease Control and Prevention, YRBS Explorer, https://yrbs-explorer.services.cdc.gov/#/graphs?questionCode=H27&topicCode=C01&location=NYC&year=2023. 
 2  “High School Students Who Actually Attempted Suicide.” Centers for Disease Control and Prevention, YRBS Explorer, https://yrbs-explorer.services.cdc.gov/#/graphs?questionCode=H29&topicCode=C01&location=NYC&year=2023. 
 3  “High School Students Who Suicide Attempt Resulted In An Injury, Poisoning, Or Overdose That Had To Be Treated By a Doctor or Nurse.” Centers for Disease Control and Prevention, YRBS Explorer, “High School Students Who Actually Attempted Suicide.” Centers for Disease Control and Prevention, YRBS Explorer, https://yrbs-explorer.services.cdc.gov/#/graphs?questionCode=H29&topicCode=C01&location=NYC&year=2023. 
4   “About YRBSS.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/yrbs/about/index.html. 
5   “Youth Risk Behavior Survey.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2023, https://yrbs-explorer.services.cdc.gov/#/. 
6   CDC. (2024b, October 8). YRBSS Methods. Youth Risk Behavior Surveillance System (YRBSS). https://www.cdc.gov/yrbs/methods/index.html.
7   Frieden, T., Jaffe, H., Stephens, J., Cardo, D., & Zaza, S. (2013). Methodology of the Youth Risk Behavior Surveillance System — 2013. CDC. https://www.cdc.gov/mmwr/pdf/rr/rr6201.pdf
8   Garrett Lee Smith Memorial Act, S. 2634, 108th Cong. (2004), https://www.congress.gov/bill/108th-congress/senate-bill/2634.
9   Garrett Lee Smith Memorial Reauthorization Act of 2022, H.R. 7255, 117th Cong. (2022), https://www.congress.gov/bill/117th-congress/house-bill/7255. 
10   Lawson, Patrick O. Suicide Screening and Surveillance of Students: Ethical, Legal, and Practical Considerations. SSRN, 19 Mar. 2021, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3786483. 
11   Ibid.
12   STANDUP Act of 2021, S. 1391, 117th Cong. (2021), https://www.congress.gov/bill/117th-congress/senate-bill/1391/text. 
13   Student Suicide Prevention Act, Assemb. B. A7762, 2021 Leg., 244th Reg. Sess. (N.Y. 2021), https://www.nysenate.gov/legislation/bills/2021/A7762.
14   Ibid.
15   N.Y.C. Dep’t of Educ., Chancellor’s Regulation A-755: Suicide Prevention/Intervention (July 25, 2024), https://www.schools.nyc.gov/docs/default-source/default-document-library/a-755-as-of-2024-07-25.pdf.
16   Ibid.
17   “About.” New York City Council, https://council.nyc.gov/about/. 
18   “High School Students Who Attempted Suicide.” Centers for Disease Control and Prevention, YRBS Explorer, https://yrbs-explorer.services.cdc.gov/#/graphs?questionCode=H29&topicCode=C01&location=CH&year=2023. 
19   National Research Council and Institute of Medicine. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Edited by Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, National Academies Press, 2009. https://doi.org/10.17226/12480.
20   Soori, Sarah, et al. “A Review Study on Psychologists' and Sociologists' Views on Teen Suicide.” African Journal of Biomedical Research, vol. 27, no. 4s, Dec. 2024, pp. 4473–4478. https://doi.org/10.53555/AJBR.v27i4S.4433.
21   “Overcoming Barriers to Family Therapy.” MST Services Blog, 27 June 2022, https://info.mstservices.com/blog/overcoming-barriers-to-family-therapy.
22   Hua, Liwei L., et al. “Suicide and Suicide Risk in Adolescents.” Pediatrics, vol. 153, no. 1, Jan. 2024, e2023064800. American Academy of Pediatrics, https://doi.org/10.1542/peds.2023-064800.
23   “Centers of Wellness for Students.” Sacramento County Office of Education, https://www.centersofwellness.scoe.net/. 
24   Fostering School-Based Behavioral Health Services: Policies and Practices. Nemours Children’s Health, Dec. 2021, https://www.nemours.org/content/dam/nemours/shared/collateral/policy-briefs/policy-brief-fostering-school-based-behavioral-health-services-policies-and-practices.pdf.
25   Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g (2020).