Suicide is the second leading cause of death for students attending American universities and colleges. The American Foundation for Suicide Prevention reports that suicide is the third leading cause for individuals aged 15-24, the very age of our traditional college students. Although the issue of suicide is often kept silent, we cannot deny the fact that it exists on our campuses. Suicide is a profoundly saddening event and on a college campus a student suicide can bring many unique challenges. Death by suicide needs to be dealt with differently than other deaths or tragedies. Universities may fear liability and/or negative publicity when dealing with suicide on their campus.
Upon further investigation about how suicide is handled on college campuses, I found an article that discusses a recent movement that completely removes suicidal students from the university. The story in this article depicts a student who was mourning the death of a friend who recently died by suicide. This student took prescription pills and after consumption he feared that he too would have suicidal thoughts so he asked a friend to take him to the hospital. Less than a day later the student learned that the university was kicking him out of his dorm room and mandating him to withdraw from his classes or he could face expulsion or criminal charges for violating the code of student conduct because the university views suicidal attempts as violent acts.
The purpose of this growing trend to remove students from the college campus is reported to be in the student's best interest. I have difficulty seeing how this is the best interest of a suicidal student. To me, the university is viewing these students as criminals instead of individuals who are deeply troubled and facing profound emotional pain. Coming from the counseling field, I will always put a student's well-being before the fear of a lawsuit. There has to be other ways that the university can protect themselves against a lawsuit as well as help the student recover. If a university has knowledge of the student's suicidal thoughts and warning signs and still chooses to ignore this instead of helping the student then a university should be sued. It is a different story if a university, however, knows of a student's struggle with suicidal ideation and makes documented efforts to provide the student appropriate resources while allowing them to remain in school.
Overall, this is an important discussion to have as university practitioners and professors. We spend considerable amount of time with students and therefore are in vital positions to detect warning signs of suicidal ideation. Parents are told to know their children, pay attention to what is going on in their lives, and be aware of altering behaviors. My belief is that once a student is a part of our campus, we have a duty to these students. We must be their parent/guardian's eyes and ears. I am not suggesting that each of us pry into students' lives and become over-sensitive and over-involved. I am suggesting that each of us at least be cognizant of warning signs and appropriate steps to take if we fear a student may be experiencing suicidal ideation.
Although providing warning signs may not contribute to our discussion on the topic for the purpose of this course, I fear I would be ignoring my duty as a counselor to not use this opportunity for a psycho-educational experience by posting these facts:
The American Foundation for Suicide Prevention report warning signs of suicidal ideation. Refer to the website for more information:
Observable signs of serious depression:
- Unrelenting low mood
- Pessimism
- Hopelessness
- Desperation
- Anxiety, psychic pain and inner tension
- Withdrawal
- Sleep problems
- Increased alcohol and/or other drug use
- Recent impulsiveness and taking unnecessary risks
- Threatening suicide or expressing a strong wish to die
Making a plan:
- Giving away prized possessions
- Sudden or impulsive purchase of a firearm
- Obtaining other means of killing oneself such as poisons or medications
- Unexpected rage or anger
The American Foundation for Suicide Prevention: "The emotional cries that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses."
My understanding is that this (dismissing a student based on suicidal ideation) is illegal. This may vary by state, but I know Virginia has a law that prohibits dismissing a student, "solely for attempting to commit suicide or seeking mental health treatment for suicidal thoughts and behaviors." I believe there is a legal precedent for students suing an institution because they were asked to leave.
ReplyDeleteA policy that asks a student to leave may violate the Americans with Disabilities Act (ADA) or section 504 of the Rehabilitation Act which prohibits discrimination or denial of benefits to those with physical or mental handicaps (which includes mental instability). Like FERPA, the Rehabilitation Act is federally funded, so that doesn't vary state-to-state.
I agree that we need to look out for students' best interests, which may be that they need to leave the institution. We also need to be careful that we arn't discriminating against students!
My concern about withdrawling students who are suicidas, is that it might make their depression worse. Being forced to leave an institution, could feel like a form of failure, especially to someone who is already depressed. Adding that type of stress could increase depression and worsed suicidal ideation. Although it may be in some students best interest to take time away from a university in order to recieve treatment, the decision might be more effective if students' believe that they are a part of the decision, instead of having it thrust upon them.
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ReplyDeleteAdding to what Kim said, the stress involved in being forced out of what has become a student's "home" (with or without a tuition refund) could easily push a student to go from suicidal ideation to suicide attempt. On campus, students have access to counseling services and health services, both of which have trained professionals that are used to working with students. Once the student leaves campus, the safety net becomes much weaker in most cases.
ReplyDeleteIf all students with suicidal ideations were asked to leave campus, then campus would be a very lonely place.
I think it is important to note that the example here is not suicide ideation, as some have mentioned. It was an actual suicide attempt. A lot of research indicates that people who attempt suicide, rather than only thinking about it, have a much higher rate of attempting suicide again.
ReplyDeleteI can understand why a university would not want to take on that liability. An attempted suicide attempt by a student has a huge impact on the community. As a former housing employee, we saw the community take a huge hit when someone attempted suicide or even threatened it. The other students feel they are responsible for the safety of the struggling student. I have talked to multiple students who were missing class, losing sleep, and suffering anxiety or panic attacks because of their fear their friend would hurt themselves if they were alone. It is evident from the article mentioned (e.g. the student who attempted suicide because of his friend's completed suicide) that a completed suicide can be detrimental to the community. Isn't it sometimes necessary to remove a student from the community for the betterment of the community?
However, I don't believe automatic withdrawal is the answer. I agree with Lisa that the mental health of our students is our responsibility. Many aren't able or have the resources to seek help on their own or even with their parents. Sometimes, parents make it a lot worse. I believe higher education needs to be much more proactive. We need to try and find the students who are struggling before they get that far.
I wonder if anyone had reached out to the student mentioned above? It should be standard practice for college counseling centers, housing staff, student affairs staff, or faculty's responsibility to reach out to students who may have been impacted by the death or attempted suicide of a student in the community.
Thank you for your post Lisa. Your post was eye opening. I had no idea that institutions have the ability to withdraw students because the student is struggling with depression and debating suicide. I do not agree with the schools stance nor do I agree with withdrawing students on this premise as a general practice.
ReplyDeleteI believe that it is the responsibility of the institutions to work with students in these situations and provide them with options. Does the student feel that they need to withdraw from the institution? If yes, help the student through the process and work with their families to be sure the student is getting the help they need. Perhaps the student does not want to withdraw. Should the student reduce their course load? No matter how the student wants to proceed, the institution should work with the student and help them seek out assistance and encourage them to get their families involved. Institutions have options and should not force a student into withdrawing.
As an administrator who is the main point of contact for families who have recently lost a one of our students (sometimes through suicide), I know how difficult these experiences can be for a college and for the families. However, we should not design our processes and policies because it is easier for the college. We should be designing our processes with the student's best interest in mind.
It should be understood that students are removed for their behavior not because they are suicidal/depressed (which would be an ADA issue). When the behavior impacts the campus community, the student should be removed. It is disappointing that people on a college campus think they can help a student suffering. To clarify, there are many professionals on each campus who have training to assist, but sometimes the best thing for a student may to go home and take some time for them. When students remain in housing, it impacts everyone, especially those on the floor and the staff working with the student. Campus housing should not be looked at a hospital in monitoring students 24/7 and their actions. If someone is serious disruptive (their behavior), it is in the best interest (most cases) that the student leave campus to get the services and help they need to get back on track.
ReplyDeleteLisa, great post. As a person who does threat assessment and student conduct, this is something we as a profession/field struggle with on a very regular basis. We look at what Katee mentioned (as in how behavior impacts community), and whether or not the student can function successfully in the college environment. Unfortunately, we also look at whether or not we are going to be sued. There is, for lack of a better word, a crap ton of case law on suicidal students, the most notable being that of the Elizabeth Shin case out of MIT. When a student attempts suicide, the University is then put on "on notice" regarding that student's behavior. Since we cannot watch them 24/7 (this isn't in loco parentis anymore!), we are then faced with the dilemma of what if they attempt again and succeed? We will lose the three prong test in tort liability. That's the practical side of it all.
ReplyDeleteThe student affairs helper in me says this is all wrong, we're backwards. We should be helping the student with all possible resources, we should be using our FERPA health and safety right to notify the student's family about the attempt and integrate the family into the solution.
This is a tricky balance with no easy solution.
Lisa, thank you for bringing attention to the unacceptable prevalence of suicide among college students. I also appreciate your desire to bring attention to and spark a dialogue about the seemingly uncommon policy of forced withdrawal for students who attempt suicide. Frankly, I am appalled by the policy.
ReplyDeleteA policy such as this undermines decades of suicide prevention and awareness efforts. Punishing a student, especially one who has sought treatment and was discharged by health care professionals. Part of evidence-based best practice efforts is to reduce the stigma associated with seeking treatment. Any policy that may prevent a student from reaching out for help is contradictory to established prevention strategies of the most preventable health threat in the US.
I don't minimize the importance of the points raised by Margaret and Jill in terms of community impact and institution liability. Absolutely, I understand that if a student's behavior is negatively impacting the college community, intervention must occur whether it is a suicidal student or something else. The key for matters surrounding suicide is the involvement of appropriate mental health treatment by mental health professionals according to the level deemed necessary by said professionals. But, I do not believe suicide attempts or ideation should be treated as a conduct issue in a punitive fashion.
http://www2.sprc.org/collegesanduniversities/developing-campus-program