College and university personnel are often confronted with several ethical and legal issues as they respond to students who present with suicidal ideation or suicide attempts on campus. This article presents an overview of the issues and the solutions that seek to address the ethical guidelines of the counseling profession and the university's goal of a sale learning environment. Solutions are applied to the creation of policies for dealing with suicidal students.
In a recent national survey, 30% of the colleges and universities housing counseling centers had at least 1 student commit suicide in the 2000-2001 school year, with 26 campuses (9.7% of the total) reporting the suicide of a student who was a counseling center client (Gallagher, 2001). The same survey found that 227 college counseling centers reported having to hospitalize a total of 1,241 students for a psychological reason in the 2000-2001 academic year. Although the rate of college student suicide is considered to be lower than in the nonstudent population (Silverman, Meyer, Sloane, Raffel, & Pratt, 1997), suicide is the second leading cause of death among college students (National Mental Health Association [NMHA], 2003).
Regardless of prevalence, any suicide or attempted suicide can disrupt the normal rhythms of learning and life for the entire campus community. Students' patterns of learning and relating are altered. Questions about protection and prevention are asked of college counselors and administrators (Bost & Ballou, 1992; Farrell, 2002; Grayson, 1994; Silverman, 1993). In particular, parents and loved ones of the suicidal student often seek to understand why they were not informed of the student's condition and why the suicide was not prevented. Such questions may put administrators and counselors on the defensive, particularly because they call into question the ethical principles of confidentiality and duty to protect and warn held so highly by mental health professionals (Farrell, 2002; Sontag, 2002). As Silverman noted, "These events raise questions about the comprehensive missions of institutions of higher education, the extent to which campuses are harbingers of more general societal problems, and the degree to which campuses are expected to function in loco parentes" (p. 329).
There is currently limited information available on the prevalence of formal policies regarding suicidal students on college and university campuses. Unfortunately, the issue is usually only highlighted by the local and national media when a suicide occurs (Farrell, 2002; Sontag, 2002). Under such scrutiny, it may be difficult for campus mental health personnel and school administrators to provide clear and adequate explanations to the public and to the families involved. Such was the case at the Massachusetts Institute of Technology (MIT) when a student, Julie Carpenter, committed suicide in 2001. Farrell, who wrote about the incident in the Chronicle of Higher Education, noted, "Like most colleges, MIT doesn't have a clear policy mandating that deans or other administrators tell a medical professional of suicide threats that come to their attention. Many college officials say ... that they trust the judgment of experienced administrators" (p. 38).
Given such examples, the benefits of having a formal institutional policy for responding to suicidal students become obvious. The purpose of this article is to inform college counselors and counseling center administrators of relevant ethical and professional issues as they work to plan, prepare, and implement suicide prevention and reporting policies and procedures at their institutions.
Relevant Considerations for Developing a Formal Policy for Responding to Suicidal Students
Optimally, an institutional policy for responding to suicidal students should include guidelines in each of the following areas:
* Assessment of suicidal ideation and the training of staff to make that assessment (Gutierrez, Osman, Kopper, Barrios, & Bagge, 2000)
* Optimal methods of responding to suicidal threats and attempts reported by campus faculty and staff
* Procedures for involuntary commitment to a hospital or inpatient mental health center
* Policies regarding who is to be notified in the event that an attempt or threat is made and associated steps to provide accountability (Archer & Cooper, 1998; Trimble, 1990)
Of course, legal and ethical issues affect each of these aspects of the formal policy. …