The 2024 Annual Report summarizes data contributed to CCMH during the 2023-2024 academic year, beginning July 1, 2023 and closing on June 30, 2024. De-identified data were contributed by 213 college and university counseling centers, describing 173,536 unique college students seeking mental health treatment, 4,954 clinicians, and 1,215,151 appointments. In this year's Annual Report, CCMH examined students with a history of suicidal or self-injurious behaviors (S/SIB) who receive college counseling center services. Specifically, CCMH examined these students' symptoms, presenting concerns, stressors and contextual factors, service utilization, and treatment outcomes. The findings revealed that students with past S/SIB, compared to those without, began treatment with more severe distress, demonstrated a higher degree of complex co-occurring problems, utilized more services and specialized care (i.e., case management and psychiatric treatment), and experienced more critical events during services. Counseling center staff provided effective support to these students, as demonstrated by their substantial improvement in distress and suicidal ideation during treatment. While these findings underscore that counseling centers provide impactful care to clients with suicide risk, these students still ended treatment with higher levels of distress and suicidal ideation than those without historical S/SIB.