Foreword
There is a well-worn blue and tan plaid shirt hanging in my closet. A gift from my late mother-in-law (who I adored), it is one of those beloved wardrobe items that is as much an old friend as an article of clothing – ideally suited for reading the Sunday paper or trivia night at the local bar and grill. For well over a decade I wore that shirt in the evening after work or on the weekend at least once most every week. I had it on a little before 10pm on the night of Sunday, April 27, 2015 when the phone rang and the dean on-call (I was vp/dean of students at Colby College at the time) told me that one of our students had killed himself in his dorm room.
The adrenaline and sorrow filled hours that followed unfolded in the way that anyone who has ever served as a first-line responder to emergency situations can appreciate and no one who hasn’t can truly understand. Time seems to stand still while hours melt away in a blur of blue and red flashing lights, rapid-fire phone calls, hastily made yet hugely consequential decisions, and conversations aimed at supporting and comforting people – parents and roommates and friends and community members – who have just been confronted with unimaginable loss and whose lives will be forever changed by what has happened; by what is happening. The ensuing days and weeks blend together and you do your best to be there for family members and students and colleagues. You strive to ask and answer the questions that need to be asked and answered. And you try to identify a way forward that will help others who are suffering similar kinds of despair find the love and care and support they need to keep them safe.
I got home sometime around 4:30am on Monday, April 28th and threw the blue and tan shirt in the hamper before climbing into bed in a vain attempt to sleep for a couple hours before heading back to campus. Sometime thereafter my shirt got washed and dried and returned to its usual place in my closet – where it has remained ever since.
Hard Conversations
College student suicide has been very much in the news lately following a May 5th New York Times article highlighting details of recent suicides at Hamilton College and the University of Pennsylvania. The Times article, which raises difficult and important questions about how colleges support students who may be suicidal and under what circumstances campus officials should communicate with those students’ families, has in turn prompted a flurry of additional media coverage including an hour-long discussion on NPR’s On Point and a particularly thoughtful and insightful op-ed in Inside Higher Ed by two experience college mental health professionals.
As heartbreaking and gut-wrenching as these conversations are, anyone who knows even a little about suicide prevention welcomes them. Public attention raises awareness. And more awareness means fewer tragic endings.
In the preface to this piece I shared a brief anecdote about a firsthand experience I had with college student suicide. I did so somewhat reluctantly because I know that the story that matters is not about me. But I included it because I think it is important to note, if only in some small way, that the counselors and deans and advisors who work to help and support students in crisis do so in good faith and in a profoundly human way.
For more than 30 years I served in college leadership roles where I regularly worked with students in crisis as well as their friends, families, and healthcare providers; most of that time as the person charged with making institutional decisions about case oversight. As a result, I probably view stories like those referenced above through a different lens than most. Having advised and counseled hundreds of students confronting mental health issues, I usually come away from an article like the Times piece with many more questions than answers. The facts that are not included and the relevant legal and policy issues that are not discussed stand out as much, if not more, than those that are.
My comments are not meant to be defensive or dismissive of criticisms or concerns raised in these stories about the actions of colleges or administrators. I know with absolute certainty that no student mental health policy or procedure is perfect. And even the most experienced and capable deans and healthcare professionals make mistakes. But it is also true that the issues at the center of these profoundly sad stories are more complex and confusing than the way they are portrayed in most public accounts.
To that end, I want to add a few thoughts to the conversation about issues and items that should be considered and assessed as we strive to improve efforts around suicide awareness and prevention.
The Only Question
Working with college students – even students in crisis – is at once a great gift and a confounding mystery. They are challenging and charming, brilliant and blockheaded, awesome and awful – frequently all at the same time. The issues and circumstances that inform and contribute to mental health crises for burgeoning adults are incredibly complicated; and constantly shifting and evolving. As such, helping college students with suicidal ideation is an imperfect science and the importance of protecting their privacy while they do the hard work of trying to get better is profoundly important. So, any decision to go outside that privacy must be made with great care. For licensed healthcare providers bound by legal confidentiality the stakes are often higher but the ground rules, while somewhat subjective, are clear – at least in principle. For administrators, the task is quite different and rarely straight forward. While it is tempting to suggest that peripheral issues like civil liability and public relations influence decision making, in my experience there has only ever been one question that matters: What is the right thing to do for the student? The rest is just noise.
FERPA
I’m not sure that there has ever been a high-profile media story regarding college student mental health that doesn’t quote some administrator saying that FERPA (The Family Educational Rights and Privacy Act) prohibits them from sharing private student information without the student’s consent. To be clear, FERPA is an incredibly important piece of legislation that provides crucial legal protection of private student records – i.e. grades, transcripts, disciplinary records, health information, etc. – by prohibiting schools and colleges from releasing such information without written permission from the student (or parent/guardian if the student is under 18). Because most college students are over 18, most colleges (appropriately in my view) take the stance that the student must give consent to release their educational records. A strict interpretation of FERPA counts parents among those to whom students must consent to release records – sort of.
The “sort of” part of the equation is that there are actually two provisions of FERPA that grant explicit permission to colleges to release information to parents without student consent. One is if students’ parents claim them as dependents on federal tax forms – which covers the vast majority of traditional age (18-22) US college students. The other exception is to notify parents of any violation of alcohol or controlled substance policy by a student. One or both often apply when it comes to students in crisis.
Additionally, many colleges send students prepared waiver forms that they can sign which permit college officials to share information with parents freely – and a sizeable number of students do so without hesitation.
So, because of the tax dependent status of most traditional age college students, the drug and alcohol exception, and the prevalence of waivers, the assertion that FERPA prohibits communication with parents is incorrect most of the time. Too often the problem with FERPA in these cases isn’t the actual law, it is some administrator’s flawed understanding of it.
More importantly, any competent advisor who is working with students in crisis will always inquire about whether or not the students have communicated with their family about their situation and whether or not it would be helpful for the advisor to speak with a parent or family member. Particularly with the current generation of students, more often than not students are communicating with their family and/or readily consent to have the administrator do so. And, if the student is not talking with family members, there is often an important reason why which may make bringing the family into the situation more problematic than helpful.
Finally, when it comes to suicide prevention, who cares about FERPA? Seriously. I’m not being glib. Nor am I discounting or disregarding the core intent and function of FERPA. But if I’m working with students whose behavior puts their standing at the college in jeopardy, or who are suicidal and pose an imminent threat to themselves and there is no compelling reason not to inform their parents, then I’m calling the parents whether it’s a FERPA violation or not. I’m not aware of any college that has ever been sued under FERPA for informing parents that their child was in danger. And even if such precedents did exist, so what? I’ll risk getting sued to take all available steps to protect a student every time – and so would just about every dean and college president I know.
ADA (Americans with Disabilities Act)
For all the talk about FERPA, when it comes to colleges taking steps to ensure the safety and well-being of students with serious mental health issues ADA is a far more influential and important piece of legislation.
Residential colleges are by design highly unsupervised settings that are rife with both stress and a slew of personal challenges under the best of circumstances. Academic demands, financial pressure, alcohol and other substance use and abuse, campus politics, family issues, and the other painful trials and tribulations that are part of coming of age unfold for young people who are living on their own and learning to navigate life independently for the first time. For students who are confronting significant health issues – especially depression and suicidal ideation – the additional challenges associated with college life can often compound the difficulties of their personal situations.
As such, the question as to whether or not students who are in crisis should take time away from school is often an important one in determining the safest and most suitable environment for them. Over the past 25 years there has been a seismic change in the way that question gets answered – largely as a result of legislative changes that are part of ADA.
In the past, colleges would routinely place a significant percentage of students presenting with self-harming behavior – including non-lethal cutting as well as suicidal ideation – on mandatory medical leaves of absence. The idea was that students with health challenges of that sort would be safer and better able to address those challenges in more suitable therapeutic environment. Additionally, it was commonplace to factor the extent to which such students’ presence on campus interfered with the ability of friends, roommates, and other students to pursue their education because of the stress and demands they experienced as a result of disruptions caused by and a sense of obligation to care for the student with health problems. However, key provisions of ADA dramatically changed the landscape around such cases by requiring schools and colleges to provide support services for students with mental health challenges and greatly limiting the circumstances under which a student can be placed on a mandatory medical leave of absence.
I am among those who would readily acknowledge that most of the changes ushered in by ADA requiring schools and colleges to provide additional support services so as to enable more students with mental health diagnoses to attend college is a tremendously good thing. Without question, the majority of students affected by the changes are capable of managing both campus life and their health challenges and it took the change in the law to move us forward as a society in this important way. But there are definitely circumstances when campus officials cannot provide the necessary level of care or support to ensure the safety certain students in crisis.
Here it is worth noting that, as any long-serving dean or campus mental health professional will tell you, for every tragic case where families were not notified about students in crisis who end up harming themselves there are dozens wherein students and their families refuse to pursue recommended treatment and vehemently resist the idea of the student taking time away from school to focus on treatment. Even after nearly lethal suicide attempts when students are literally still in intensive care units under observation, rather than focus on next steps for their care and treatment, many students and families begin making the case for an immediate return to campus – often citing ADA requirements for mandatory medical leaves of absence.
My point isn’t that ADA is bad or that campus officials don’t get it wrong sometimes. My point is that these cases are always more complex and involved than how they seem in after-the-fact news accounts. And, from a legal standpoint, ADA is a far more important piece of legislation with respect to suicide prevention than FERPA.
Experience Matters
As the recent news stories about college student suicide make clear, faculty, counselors, and a range of administrators who advise students play a vital role in providing effective support and assistance to students in crisis. Over the last decade student-of-concern teams made up of experienced professionals across a number of departments and programs have become standard elements of campus support resources. Such teams generally meet weekly and routinely review cases involving students who have popped onto the radar for any of a number of reasons. The thinking behind student-of-concern teams is that frequently students who are struggling in one realm of campus life may be struggling in others as well. So, by raising awareness across a number of campus venues the college is better able to provide care and support for students. As a result, the overall quality of care is better and far fewer students slide through the cracks than in the past.
But student-of-concern teams are only as good as the information they receive from other sources. And to that end there are a few issues that warrant serious attention. The first is that both doctoral programs that prepare scholars for college teaching and colleges as employers need to be more deliberate and intentional about educating faculty to recognize warning signs of students in crisis and training them on how to make referrals and/or access support services. Moreover, it must become an unequivocal requirement that faculty notify designated administrators if a student has stopped attending class, no-showed for an exam, or failed to hand-in assignments. While faculty cannot reasonably be expected to deal directly with student emergencies, insofar as failure to meet academic obligations is one of the most prominent warning signs that a student may be in crisis, course instructors must be accountable for notifying someone who can help when a student ceases to attend or perform in class.
Similarly, senior administrators must ensure that individuals in key support roles – deans, advisors, counselors, and residential life staff – are adequately trained to ask the right questions and to respond to students in crisis. Most importantly, those in positions with authority for making determinations about such matters need to have sufficient experience to serve in those roles. While many more students with chronic mental health issues are forthcoming about their conditions and proactive about securing care than in the past, it is still the case that many of the most troubled students only come to the attention of the college as a result of academic, social, or disciplinary situations. Accordingly, if the advisor or dean or disciplinary officer who does the follow up lacks the requisite experience to probe beyond the surface, critical situations are more likely to remain concealed and fewer students in crisis will get the help or support they need.
There is no Perfect
Finally, as Peter Lake and Paul Polychronis point out in their Inside Higher Ed op-ed, ultimately there is no perfect solution for college student suicide. Sadly, sometimes there are no obvious warning signs – no class absences or missed assignments or failing grades; no lethargy or mood swings or outward signs of despair. Sometimes people in the throes of unimaginable pain conceal all of it and there is no reason why anyone would suspect they are suicidal until it’s too late. Other times the disease is too much, the pain is too great, and even people getting the best possible care and support take their own lives.
So, hard as it is, we have to accept that most of the time when suicide occurs, blame cannot and should not be assessed to anyone. Moreover, it is especially unfair – and dangerous – to vilify people who provide care and support to those suffering from the most severe cases of depression and potential suicidality. Of course, there must be accountability for acts of reckless neglect or gross negligence. But the horrible truth is that suicide will never be 100 percent preventable and blaming those working to help people in crisis is profoundly unjust.
There is no part of addressing college student suicide that is easy or in any way uplifting. There are no silver linings. Anyone who has experienced suicide even peripherally knows that the questions will never be adequately answered, that the guilt survivors feel – no matter how unfounded – doesn’t go ever away, and that the relentless chorus of what-ifs will never go silent.
But we can and must commit to do better. To develop new ways to raise awareness. To give students and faculty and staff better tools to respond to students in crisis. To establish more effective ways of communicating and working in partnership with parents and families and friends when students need help. Every step forward matters.
Afterword
I know it’s silly not to wear a shirt that I love just because it is coincidentally connected to a tragic event. I understand that my shirt in no way influenced the unspeakable pain that led a smart, talented, outgoing, immensely popular, and truly loved young person to take his own life. And that wearing it again would not spark some other horrible happening. I have reached for that shirt a few times with the full intention of putting it on or adding it to a bag of clothes we’re donating to Goodwill. But I always end up finding that I can’t quite do either. I can’t forget. I don’t want to. It’s too important. That student – and his family and friends and everyone who was impacted by his life are too important. And doing what I can – no matter how small or seemingly insignificant – to help others suffering in the ways he did to find a path beyond their pain to a better, safer, and happier life is too important.
So, there is a well-worn blue and tan plaid shirt hanging in my closet.
-JST
Note: This post has been simultaneously published on My College Wisdom and the James Terhune Consulting Blog
