Abstract

In response to persistently high suicide rates in the Tohoku region of Japan, Yamagata Prefecture implemented a school-based mental health education program called “How to Express SOS,” aiming to promote help-seeking behaviors among children and adolescents. The initiative involves collaborative development of model lessons by educators, public health nurses, and university faculty. Its core philosophy integrates both population-wide and high-risk approaches, emphasizing self-disclosure, mutual support, and community-based mental health literacy.

Interactive techniques, such as metaphorical use of paper balloons to visualize psychological stress and recovery, help students internalize the concept of resilience. Local health professionals are introduced in classrooms to provide accessible support networks. Early outcomes show increased student willingness to seek and offer help, and a reduction in youth suicide rates—from an annual average of 8 (2018–2022) to 1 in 2023.

This opinion piece presents a culturally grounded and systemically integrated model of suicide prevention. It offers transferable lessons for public health and nursing professionals engaged in mental health promotion and school-based interventions.