We are All at Risk of Suicide

Institutional responses and responsibilities to students who are potentially suicidal have been widely discussed recently. Institutions seem caught in a web of ambiguous conflicts. Do we have a duty to prevent suicide attempts? If there is such a duty legally or ethically, what evidence constitutes a credible basis for action? What kind of action is warranted? When we admit a student, we have a duty to support that student academically. However, academic support may involve a range of emotional supports that allow that student to persist with full access to his or her academic skills and abilities. We know that cognition, emotion and behavior are highly integrated so that separating one from the other is almost impossible. In cases where students experience either acute or chronic psychological distress, the availability of emotional support and/or medication may be the determining factor in a student’s ability to succeed academically. Approaches to helping at-risk students should acknowledge this integration and focus on student success wherever possible. Keeping students in school with appropriate support may be the most beneficial thing we can do for them.

Institutional responses to students at risk should be shaped by policy that takes into account the welfare of individual students, the campus environment in which those students study and live and the nature and mission of the institution. According to legal expert Dr. Gary Pavela only institutions with custodial missions, such as prisons and mental hospitals, are legally responsible for preventing suicide. The mission statements of colleges and universities typically address at least two elements that are pertinent to this conversation: student learning and student character development. From an ethical perspective, institutions should consider how they can help all students learn, including students at risk, and how they can create conditions in which those students are least likely to hurt themselves or others as they continue learning. According to Pavela, institutions should be “working harder to keep students at risk of suicide enrolled, working with them, giving them the help they need and not finding faster, more creative ways to remove them” (Hoover, 2006, A39).

The ACPA Statement of Ethical Principles is designed to give guidance to individual members of the association as they carry out their professional responsibilities. Members are expected to act with benevolence and prudence toward students and colleagues and to honor the principles of autonomy, justice, fidelity, not harming anyone (non-malificence) and helping (beneficence) wherever possible. Although the ACPA statement does not address matters of institutional policy directly, when individual members are involved in policy-making, we are expected to support the principles identified in the code. If we are asked to review policy as it is being written, we should keep these principles in mind as we consider the consequences of new policies. Although risk management is a significant concern to institutions, ethically it should be balanced with institutional fidelity to students and mission- keeping promises to help students learn and develop the skills and perspectives often cited: effective, engaged, multiculturally competent citizenship, critical thinking, and effective life management, decision making and communication skills.

Student conduct codes function as contracts between students and their institution. These codes typically state what kinds of behavior are impermissible and may also state, in more general terms, what kinds of behavior are desirable. Many codes contain language that proscribes behavior that “endangers self or others”. Student comments indicating suicidal ideation or intention such as remarks made to friends, to staff members or in written assignments constitute verbal threats and should be taken very seriously. Campuses typically employ or have access to professionals who are trained to assess suicide risk and to make judgments within their own scope of professional training about degree of risk and protective steps to be taken, if any. Students who act out by cutting, carrying weapons, or engaging in any other visible self-destructive behavior, are generally violating some element of the institutional conduct code and can be confronted through formal charges or informal conversations through the campus judicial process. This approach honors fidelity, keeping institutional promises to due process, as well as autonomy; permitting a student to speak with a professional staff member about personal behavior, choices and consequences. The Americans with Disabilities Act (ADA) may also protect some at-risk students because of psychiatric diagnoses. The principle of justice comes into play for these students because the ADA requires a specific and lengthy inquiry to determine whether or not the institution is meeting the needs of these students. Institutions may incur greater liability by violating ADA protections than they do by keeping students enrolled. The key exception to this approach is the presence of a demonstrable and immanent risk to self or others.

We live in a high stress era. Some stress is personal, such as the cost of college tuition, struggles with identity, with peer relationships or with the baggage from dysfunctional families and abuse. Global stress such as fears of economic instability and terrorism is also a factor. The body, mind, spirit of a human being does not distinguish among the various sources of stress. The physiological reaction to stress is integrated and whole. One of the signs of extreme stress is despair or hopelessness. Among those of us who are aware of the many issues burdening our students and ourselves, despair seems like an understandable, if painful response. We can certainly understand how students, particularly those in the 18-24 year old group, might think of suicide as the way out. We know that extreme, prolonged stress impairs cognition and decision-making. Mood disorders and some of the medications that are used to control them may also impair cognitive function. Chronic substance abuse, begun in early adolescence, can impair cognitive function as well. All of this evidence points to the need for the demonstration of the professional virtues in our relationships with students and colleagues: prudence, integrity, respectfulness and benevolence. ACPA members who suspect that students are considering suicide should treat those students with respect and benevolence, or good will, rather than suspicion. We are obligated to behave with prudence, thoughtfully and carefully, to consult with supervisors or mental health staff about appropriate interventions and to document our efforts as we design effective interventions. Integrity, the fourth virtue cited in our code, requires that we act in accord with our professional values and maintain consistency in our behavior in such serious situations. Integrity requires that, even in the face of a major concern about student welfare, we demonstrate the other three virtues consistently.

Beyond the demands of an immediate situation, ACPA members also have a responsibility to consider the context of students’ lives and their hopes for the future. In Big Questions, Worthy Dreams (2000) Parks writes about “mentoring young adults in their search for meaning, purpose and faith” (subtitle). Creating mentoring communities is Parks’ way of describing the work we can do with students who are wondering what their lives will be like, what they may hope for or whether hope remains alive in their world. It is possible that the greatest anguish involved in thoughts of suicide is the belief that a person is alone in the world, ashamed of his or her despair and unable to break out of the isolation or search for connections with others. Many campuses are currently engaged in discussions of student spirituality which is one approach to helping students think through questions about life’s meanings. The student affairs profession has long been involved in helping students think about questions of meaning and purpose in life, regardless of whether we proceed from secular or faith based perspectives. The most important thing we can do with and for students, regardless of their “at-risk” status, is to help them think about what they value, what they hope for and how they can develop meaningful relationships in their lives now and in the future. Thinking about the unthinkable is less frightening in the presence of others who care about us. Knowing that others have considered the same thoughts about purpose, meaning and despair can be very reassuring to students who think that giving up is an acceptable option.

In this era of virtual reality, many of our students have failed to develop the relationship skills that are essential to creating satisfying and happy lives. If we can model benevolent, respectful behavior in our work with students, we will be planting the seeds of the mentoring community. If we, as survivors of adolescence, can help students think and talk about issues that we have learned to manage as adults, we will be planting additional seeds for the development of courage and confidence. Because we, as a profession, have adopted the ethical principles of doing no harm, helping where possible and supporting autonomy, we are in some sense obligated to raise the big questions and help our students develop worthy dreams of their own. Through the creation and structuring of dialogues within student peers and among students, faculty and staff, we are in an ideal position to legitimize conversations about significant issues and develop mentoring communities. Individual students who are in crisis and “at risk” of suicide are powerful magnets for staff attention, but all students deserve the opportunity to consider the significant questions of their own lives. Many of them will benefit from having these discussions in a campus context. In some sense we are all at risk for suicide. We have all experienced despair. We all need opportunities to express our darkest thoughts, be received by people who care about us and affirm our possibilities for living worthwhile lives.

References

• Hoover, E. (2006 May 19) Giving them the help they need. The Chronicle of Higher Education. LII,37.  A39-41.
• Parks, S. (2000). Big questions, worthy dreams. San Francisco: Jossey Bass.
• Pavela, G. (2006, July 14). Personal conversation.