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New Suicide Screening Tool for ERs Identifies Teens at Risk

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With an increasing number of teens making mental health emergency room visits, the introduction of a new suicide screening tool may help save lives. Called the Computerized Adaptive Screen for Suicidal Youth, or CASSY, it identifies teens at the highest risk of making a suicide attempt. In a test with close to three thousand adolescents, CASSY was 88 percent accurate in its predictions.

The development of the suicide screening tool was a direct response to the current teen mental health crisis. The number of teens suffering from trauma, anxiety, depression, and suicidal thoughts continues to rise, and pandemic-related disruptions to mental health services are making the problem worse.

Why Teen Mental Health Emergency Room Visits Are Rising

The mental health repercussions of the pandemic have disproportionately affected teens. Remote schooling and social isolation; family stressors, such as financial and health worries; and increased screen time are among the issues contributing to the teen mental health crisis. In addition, young people who have experienced childhood trauma are being re-triggered by the trauma of the past year, experts say.

At the same time, it has become more difficult for many teens to access mental healthcare. A World Health Organization survey of 130 countries, including the United States, found that close to two-thirds of the countries were experiencing disruptions to mental health services for children and teens as a result of the pandemic. In some cases, mental healthcare was provided through school and is no longer available. Or parents have lost their jobs, and therefore don’t have insurance to cover mental healthcare. In other cases, families aren’t able to find in-person care and don’t have the technology required for telehealth visits with a mental health professional. Consequently, 60 percent of youth in the United States with major depression do not receive any treatment at all.

Without ongoing care and proper treatment, teens end up in the emergency room. Sometimes they have expressed suicidal thoughts or attempted suicide, and sometimes parents or caregivers don’t know where else to take them for help with mental health symptoms. Between April and October of 2020, the proportion of mental health emergency room visits for teens (ages 12–17), among all teen ER visits, went up by 31 percent as compared to the same time period in 2019, according to a CDC report. Furthermore, this age group had the highest proportion of ER visits related to mental health.

“Many mental disorders commence in childhood, and mental health concerns in these age groups might be exacerbated by stress related to the pandemic and abrupt disruptions to daily life. The majority of [emergency rooms] lack adequate capacity to treat pediatric mental health concerns, potentially increasing demand on systems already stressed by the COVID-19 pandemic.”


Stats on Teen Suicidal Ideation 

The teen suicide rate was already increasing dramatically before COVID, with a 60 percent rise between 2007 and 2018. Now even higher rates of teen anxiety and depression, coupled with limited access to mental healthcare, have led to more families seeking teen suicide help. A study published in the journal Pediatrics found that rates of suicidal ideation (thinking about and planning suicide) and suicide attempts rose significantly among adolescents ages 11–21 in 2020. In fact, rates of both ideation and attempts were almost twice as high in the months of February through July 2020, in comparison to the same months in 2019.

Research shows that teenagers are among the demographics that are most likely to experience elevated suicide risk during the pandemic. In addition, teens are at even higher risk if they fall into any of the following vulnerable categories:

  • Having a previously diagnosed mental health condition
  • Socioeconomically disadvantaged
  • Living in a home where domestic violence or abuse occurs
  • Residing in a rural area
  • Belonging to a marginalized racial or ethnic group
  • Identifying as LGBTQ+
  • Being male.

The New Teen Suicide Screening Tool 

In response to the growing number of adolescents and families seeking teen suicide help, a group of more than 20 researchers from American universities and teaching hospitals set out to create a tool to identify adolescents who are at the greatest risk of suicide. To develop and test CASSY, the computerized suicide screening tool, they administered the screening to thousands of adolescents (ages 12–17) who were making emergency room visits.

Subsequently, the research team tracked the number of suicide attempts among the study participants over the next three months. The results showed that CASSY was able to predict teen suicide attempts with 88 percent accuracy. This represents a clear improvement over the 60 percent accuracy of the commonly used Ask Suicide-Screening Questions (ASQ) tool. Unlike the ASQ and other teen suicide screenings—including the Columbia Suicide Screen, Risk of Suicide Questionnaire, Suicidal Ideation Questionnaire, and Diagnostic Predictive Scale—CASSY asks about specific mental health symptoms. Rather than answering yes/no questions, teens give more detailed information about their sleep patterns, depressive symptoms, issues with family, feelings of hopelessness and agitation, and ability to concentrate. Hence, this personalized approach provides more accurate results, researchers say.

Ideally, the CASSY suicide screening tool would be given not only to teens making mental health emergency room visits, but also to teens in the ER for any other reason. Therefore, teens at high risk, whether or not they had expressed suicidal thoughts, could be immediately identified and connected with appropriate mental health services, before a crisis occurs.

“There are many reasons young people may not share suicidal thoughts, possibly because they’re ashamed, or someone reacted in a way they didn’t feel was helpful when they shared suicidal thoughts or sensitive information in the past. If we screen only for suicidal thoughts, we will miss some high-risk adolescents.

Cheryl King, lead researcher, CASSY team

Accessing Teen Suicide Help

Hopefully, the CASSY teen suicide screening tool will help healthcare providers to identify suicide risk and connect teens with the care they need. Ultimately, all teens in need of mental healthcare should be provided with access to high-quality treatment, whether outpatient care, residential treatment, or emergency teen suicide help.

If your teen is experiencing a mental health emergency, seek care at an ER immediately and/or call the US National Suicide Prevention Lifeline at 1-800-273-TALK (8255). To find treatment for a loved one or client, contact Newport Academy today. Our Admissions experts can help determine what level of care is needed, and support teens and families to begin the healing journey.


Pediatrics. 2021 Mar; 147(3): e2020029280.

JAMA Psychiatry. 2021 Feb; doi:10.1001.

JAMA Psychiatry. 2021;78(4):433–438.

CDC Weekly. 2020 Nov 13; 69(45): 1675–1680.