Background: Although there are limited epidemiologic data on suicide among college students, suicide is likely the second leading cause of death among college students in the United States.For this reason, a comprehensive approach to suicidal prevention on university campuses has become a high priority among administration and mental health professionals.The issue has risen in prominence as younger students with significant mental illnesses have undergone successful treatment that has permitted them to advance into college and graduate levels of study.The rigor of their academic experience, distance from home and support systems, and the need for expertise in managing such students and their medications has increased the demands on college health services.The University of Pennsylvania (UPenn) is a well-established institution of higher education in the United States with extensive undergraduate and graduate programs.It is located in a large urban, cosmopolitan area, drawing students from local, national and international origins with diverse cultural and ethnic backgrounds.Methods: UPenn Counselling and Psychological Services (CAPS) has implemented an integrated and comprehensive approach to suicidal prevention on campus.This includes 1) Direct communication/policy setting between the CAPS Director and the UPenn senior administration 2) Providing on campus psychiatric care and psychological counselling through multi-disciplinary teams staffed by psychiatrists, psychologists and clinical social workers 3) Crisis response and management with 24/7 on-call coverage and access to remotely secured medical records 4) Direct liaison with campus security, residential staff and hospital emergency rooms 5) a focus on vigilance and on identifying at-risk individuals and behaviours through a close collaboration between college staff and students peer groups, with outreach to students in distress 6) a systematic preventive outreach approach to reduce student stress by training, workshops, online education to the university and the community, to de-stigmatize mental health issues and alter social norms.Results: The above development uses an iterative approach with data from CAPS on-line surveys, workshops and on-call medical records to identify efficient ways to engage university students and their peers and to prevent dangerous and suicidal behaviours.Conclusion: 1.An integrated and comprehensive approach on suicidal prevention at UPenn has promoted mental health and reduced suicide among students.2.Campus-student peer support is a key element in an effective suicide prevention program.