While the annual American College Health Association conference in New York City was filled with many questions this year – where the profession is headed and how to assist mentally ill students looming large among them – the problem that is attracting ever more attention from many health professionals continues to be the ever-present risk of suicide on campus.
Several campus mental health experts offered their advice to fellow members on ways to prevent suicide attempts and how to deal with them. Some of the most valuable information, according to many attendees, was advice from professionals who said they’ve found measurable success in preventing suicides by proactively -- and firmly -- dealing with students who have considered and attempted suicide.
“I think this has already gotten a lot of attention in college health,” said Chris Brownson, a counselor at the mental health center at the University of Texas at Austin. “But a lot of us are still trying to deal with these issues, [especially in terms of] integration of effective programs and prevention.”
Officials with the Jed Foundation, which was founded in 2000 by the family of Jed Satow, who committed suicide as a sophomore at the University of Arizona, presented some illuminating statistics on the prevalence of suicides. About 1,100 college students die from suicide each year, which averages out to three per day, and 1.5 percent of all students report at least one suicide attempt. Meanwhile, 90 percent of all people who die by suicide have a diagnosable mental illness, and fewer than 20 percent of all students who die by suicide have ever sought help from college counseling centers.
Not all institutions have fared equally in terms of suicide rates. Paul Joffe, director of the suicide-prevention program at the University of Illinois at Urbana-Champaign, noted that from 1976 through 1984, 19 students had committed suicide on campus. Since 1984, he said the suicide rate has been reduced by about 50 percent. The number of successful suicides is well below the suicide rates of most institutions of similar size and nature as the University of Illinois.
Joffe credited this feat with the implementation of a “mandated treatment program” about 22 years ago, whereby a student who attempts suicide or reports that he or she is thinking about suicide is required to attend at least four sessions with a campus mental health expert. He says that such students are told that they have to attend the health service program as an "assessment for safety."
Prior to the mandated program, Joffe said that the campus experimented with a more empathetic approach, which allowed at-risk students to choose whether or not to come to the four sessions. He said that less than five percent of students attended the sessions. “Those who were most in need were most reluctant to get help,” he reflected.
He and his colleagues soon decided to shift the attention and power away from the individual student to the mental health experts at the campus health center. “I’m not so sure you want to make a person the center of things who has maybe made a really silly decision after a break-up,” he said. “We’re the center -- if you want to be a part of the campus community, you have to commit to the four sessions.”
“We’re pro-enrollment as long as they adhere to our rules,” Joffe added. He said that the suicide portion of the counseling center looks like “a conduct and discipline office.”
To date, about 2,000 students have gone through the mandated sessions, and only one has withdrawn from the institution, having chosen not to participate in the sessions. Over 30 percent of students have chosen to go beyond four sessions, according to Joffe.
Some who listened to Joffe had questions about the legalities of mandating such a program. Joffe explained that they don’t use the words “treatment” or “psychotherapy” in their requirements. He said, too, that usually after four sessions, a student who is in serious trouble will verbally consent to either leaving the university or getting more intense professional help.
In reference to a question about the ongoing Jordan Nott case against George Washington University, Richard Kadison, the chief of mental health services at Harvard University, explained that his institution has an involuntary medical leave policy, but the university has used it only once in the past ten years.
“We tell students, ‘If you want to stay in school, here is what you have to do.’” said Kadison. If they don’t take the steps outlined by the Harvard counseling center, which are similar to those at the University of Illinois, then they are asked to leave.
“You lose all leverage once you apply it,” cautioned Joffe.
“If you think the student needs to take a leave of absence, and you can make them feel that’s what’s best for them,” said Joanna Locke, a program director with the Jed Foundation, “I think you can avoid litigation.”
Based on research the Jed Foundation has conducted at 40 institutions nationwide, Locke said that it’s best for a campus health center to operate on a case-by-case basis, never explicitly saying that if a student takes some specific action, he or she will be kicked out of an institution. Joffe said, too, that it’s important for policies not to become so broad that they cover behaviors that aren’t suicidal.
Several health officials at the conference noted that there are many instances where students successfully attempt suicide the first time, and this is a problem that many acknowledged is much more difficult to remedy. Such students tend to be male and keep their feelings to themselves.
“We’re still scratching our heads on what to do about it,” said Joffe, saying that public health campaigns focusing on depression and reducing stigmatization for seeking help are the best – and only – known routes to pursue at this time.