Redefining sucide risk

This is quite misguided and simply dumb. The problem with suicide is that it is lethal event, but quite uncommon and so difficult to predict. And college students are not a particularly high risk group, relative to depressed single, elderly men, despite all the media hype.

The problem is not solved and is even compounded by getting too broad a definition of “at risk". Thsu, the problem with the author’s expanded definition of risk is that it diffuses prevention efforts by targeting persons who are unlikely to act on their thoughts.

We might conclude from this study that suicidal thoughts are a quite common phenomenon and, given relatively so few people who have them actually complete suicide, targeting suicide prevention efforts to such a loose definition of “suicidal” will fail.

Note: I was a scientific advisor to the German Alliance against Depression and I am currently External Advisor to the European Alliance Against Depression, a 17 nation effort to reduce suicidality and improve treatment of depression funded by the European Commission.

James C.Coyne, Professor of Psychologiy in Psychiatry at University of Pennsylvania, at 7:30 am EDT on August 18, 2008

So what do you do about it?

It is a known fact that college age people-18-22-are at the highest risk for mental illness such as schizophrenia, depression, bipolar disease, to name just three. Suicide is basically death from these diseases. Violence like what we saw at VA Tech is also a “symptom” of mental illness. So now that you know that many college students contemplate suicide and possibly violence what do you do about it? Depend on the college counselors? That’s like asking for a bandaide to cure a broken arm.

There is a great stigma associated with seeking advice and guidance from the school shrink but even if you do college counselors are highly unqualified to deal with mental illness, they are not leaders in their field, and most of all they are hampered by FERPA which completely ties their hands and binds them to the free will of their “adult” students. It prevents them from getting the family of the student involved as well as getting outside help from more qualified professionals without the student’s express permission or until a real crisis exists—attempted suicide or violence.

What colleges really should do is start rethinking their dorm and living situations. There should be full fledged experienced adults—NOT STUDENTS OR PEERS—living and dealing with the students in their dorms. Adults who are qualified to recognize drug and alcohol use and can actually prevent them from being used in the dorms. Adults who are qualified to recognize mental health problems. Adults who have the power to monitor students and who can recommend a course of action before a problem gets worse. Adults who can establish a basis of trust and rapport with students and can act as a liason between them and their family if a crisis arises.

As a mother of an 18 year old who went to Manhattanville College and there as a freshman experienced rampant and unobstructed drug use in his dorm and who then developed mental health issues I can say, that the absolute worst mistake I made was going to the Director of the Counseling Center for help. I didn’t realize her administrative duties as both head of the counseling center and the health center did not make her the best or the most qualified person to seek help and advice from. And I didn’t understand the power FERPA gave her to shut me out of my son’s life. She didn’t have the time or the inclination to aid my son and because he was 18 found the most expedient way to deal with us was to advise him to put his parents on a Persona Non Grata list and then encouraged and allowed him to live an abnormally isolated existence on campus. She did not see his behavior as risky or that he posed a harm to himself or others. Manhattanville College threatened us with arrest by the local police if we stepped foot on campus accusing us of being overly involved, abusive parents and never once provided a recourse for us to deny the blatantly false accusations. Citing FERPA, they prevented us from contacting or helping our son. As soon as the semester was over he disappeared and we have spent thousands trying to locate him. I am thankful he did not commit suicide or a violent act on campus but ironically if he did it would have allowed us to step into his life and help him.

Whatever the statistics for potential student suicide rates, mental illness, violence, drug and alcohol abuse or addiction that are on college campuses—it doesn’t matter one bit because colleges cannot and will not act in the best interest of the student BEFORE they are in crisis and they will use FERPA as the big reason. This ridiculous law is what needs to be dealt with before any plan of action can be taken to really provide students with the help and support they need when making the transition from home to college.

Again, I urge all parents, if they suspect something is wrong with their adult child, to never, ever get the college involved. FERPA has created a solid boundary between you and your son or daughter and it is left up to the college as to how they interpret and enforce it. Once that tuition is paid and your child turns 18 you are legally inconsequential.

ccbassin, at 9:10 am EDT on August 18, 2008

what to do about it

Maybe that’s what happens in New York... but if you live in Indiana, where they passed a law in 2005 (SEA 529) requiring mental health testing for ALL “children” ages 0-22, you not only can call upon the education system to get involved with your child’s mental health, but can expect them to, by law. You read that right— “children” up to and including age 22. The state has ordered and given that responsibility to the SCHOOLS! So, my advice is to send your kids to school & college in Indiana if you want schools to take responsibility for kids’ mental health. ... but don’t plan on having any say-so yourself. According to news reports, once the state takes over you’re out of it. And as far as stigma goes, the only “stigma” today is in the minds of the people being treated. Just about everybody I know has either had some sort of counseling or is on Prozac, or both, and I have never heard anybody talk about or act embarrassed by it.

Interested, at 10:00 am EDT on August 18, 2008

Boy, we really do not know what to do with our 18- to 22-year olds, do we? Back in the late 60s when I was in school in loco parentis held sway. When my kids were in college, we tuition-paying entities were deemed “loco parents” if we tried to have any role in the experience we were providing to our children (yes, children; that’s the correct word for their relationship to us), often at great expense and sacrifice.

The rush to judgment and the arrogant dismissal evident in Jones’s comment are all too common in dealings of colleges and universities with parents.

Maybe it would be better all around if people didn’t go to college until they were 23. Students would be unequivocally adults, with richer life experience to bring to their studies. Underage drinking wouldn’t be an issue. Dorms probably would go the way of the dinosaur, since how many adults really want to live like that? Parents’ income wouldn’t be considered in the financial picture. And students paying their own way would have a great incentive to finish as quickly as possible, leaving them less time to get depressed about school. Sounds like a plan to me.

Kathleen, at 11:00 am EDT on August 18, 2008

Another Viewpoint ... Possibly Enlightened

It is difficult for me to respond to this article because, for the most part, I am an advocate of suicide, not only for the terminally ill and those near the end of their lives who are just “tired of living,” but also as a “solution to life’s problems.”

I have very seriously contemplated suicide myself ... I don’t think during my college years, but certainly while in high school and even later. I have thought about it a great deal, I have read many articles and books about it, and, if I live long enough, I think it is very close to a certainty I will choose suicide to end my life.

My objection to this article and to much of what you will read about suicide in the popular literature is the general perspective that (1) suicide is “wrong” (attempting it is strangely illegal in some places), (2) we should do everything we can to prevent it, and (3) suicide and depression are inextricably related.

I take depression – whatever that mean – to be part and parcel of almost everyone’s life. I would go so far as to suggest that a person who is not, from time to time, depressed is simply not living life as it should be lived. As a consequence, if you take a serious look into anyone’s life – even those who are not “candidates” for suicide – you will find precisely the “depression profile” that we use to explain a particular individual’s choice of suicide. It is very close to being a self-fulfilling prophesy.

I think that’s an important perspective, because, especially for young people, it strikes me that there are interesting alternatives to ending one’s life. Just pretend for the moment, however, that I am right about causes. Suppose, as was almost surely true in my case, thoughts that initiate contemplation of suicide are much more disturbing than they are depressing (and no, I am not playing with words). Who am I? Why am I here? What is the point? Why is there so much “evil” in this world? What will I do with my life? Anyone who would equate a young person’s disturbance vis-a-vis not being able to find answers to those questions with depression is just not thinking. And anyone who thinks a regimen of Prozac will help a young person answer those questions has spent too much time reading the literature in Borders’ self-help section.

I will go further. Although I think the percentage of the religious amongst us will remain high, I am confident that the number of thoughtfully non-religious (agnostic and atheist) will increase dramatically during the next 50 years. As that happens, our sense of the meaning of suicide will evolve, the incidence of suicide will increase, and there will be considerable pressure to change our antiquated laws and narrowly-focused theories about suicide. I wish I could be around to see that happen, but alas .... Nevertheless, I can assure you ...

1. As this transition takes place, it will be useful to know as much as we can about the mindset of those who choose suicide.

2. Among other things, we will come to appreciate that the “selfishness accusation” is completely bogus. The argument goes, “anyone who chooses suicide is selfish because s/he does not take into account the feelings of those who are left behind.” Nonsense! It is those “who are left behind and feel this way who are selfish, because their perspective is essentially, “no matter what conditions and circumstances would lead a person to think suicide was a rational action, s/he should live with them because, otherwise, it will be hurtful to me.” Whew!

Here are two interesting articles about suicide. First, from a recent New York Times article ...

http://www.nytimes.com/2008/07/06...To+End+It&st=nyt&oref=slogin

And, in support of my overall theme about rational decisions to choose suicide, read about Carolyn Gold Heilbrun’s decision to end her life ...

http://nymag.com/nymetro/news/people/n_9589/

P.S. Since I hate to end on such a serious note, let me take this opportunity to suggest that you add Nick Hornby’s “A Long Way Down” to your reading list ...

http://www.borders.com/online/store/TitleDetail?sku=1594481938

P.S. Oh yes, read the IHE article, “When a University Kills Suicide Research” ...

http://www.insidehighered.com/news/2008/07/07/suicide

Frizbane Manley, at 12:25 pm EDT on August 18, 2008

James Coyne-While college students as a whole do not kill themselves at the same rate as elderly white men, sub groups of college students (i.e., diverse groups) have rates as high or higher as the elderly. These populations were part of the study and this is a pressing problem for them.

I recommend that before you use terms such as “simply dumb” you take a closer look at the article. The authors took great pains to narrowly define suicide. As a scientific advisor you might want to consider choosing other terms more carefully. “completed suicide” is not an appropriate term, the standard in suicidology is “suicide death".

Participant university, at 2:45 pm EDT on August 19, 2008

Still no solution?

It was interesting to read some of the comments to my experience at Manhattanville College. I was not submitting an article, research paper or thesis although I could write a book replete with all. For the sake of brevity I did not share the myriad facts, figures or research I undertook and I barely touched on the details of what is a perfect example of what can happen when a college does not have a well thought out prevention strategy for what happened to my son or even a real policy on how to deal with it. And I stress, the outcome could have been suicide or violence on or off the campus. The college administrator I dealt with sort of made it up as she went along and she was an administrator and ultimately not qualified to make judgements or assessments regarding my son’s behavior.

You must trust that I consulted many legal and health experts in both the fields of higher education and mental health and I have very well thought out opinions about how Manhattanville could have handled things much differently to the benefit of all.

The real point of why I shared my experience with you was not to seek advice on FERPA, parenting or the feelings of my son, but it was to offer a possible prevention strategy for the serious problems facing colleges and parents regarding mental health issues as well as risky behavior of students on campuses. Behaviors which are often but not always intertwined. These include the use of drugs as well as underage and binge drinking.

It’s too bad my experience was not used to intelligently discuss real solutions to these very real problems. Problems that often result in tragedy.

I think tighter and wiser dorm regulation, overseen by experienced and trained adults, not students or peers, will have a very direct and positive impact on the behaviors students participate in on campus. When serious concerns are raised, involving family is key—parents are not the enemy.

Another thought is somehow involving the guarantor of the student loan as well as the lender to perhaps get the student to sign a contract under which FERPA has no bearing and legally ties the student behavior, performance even taking medication directly to the source of money. That way recognizing and treating negative behavior is not strictly between the college and the student and the consequences of said behavior are clearly outlined.

These are the real problems you should be solving and what the original article is searching for. Instead of looking for government regulation or changing laws to lower the drinking age, why don’t you start exerting more stringent oversight over what you can actually control. Where is the leadership?

ccbassin, at 7:45 pm EDT on August 21, 2008

not a constructive exchange

I am the sister of ccbassin and I have followed my nephews case from the beginning. I am so appalled at the posts of Larry and. To call a parent you don’t know in a case you are only marginally familiar with — delusional, a failure etc. is so incredibly rude and inconsiderate, not to mention unnecessary during a supposedly serious discussion about student mental health. my sister and her husband are incredibly dedicated and caring parents and her son came from an extremely loving middle class family that values the individual and gave him every advantage. he was an outgoing, loving, intelligent, sensitive, ambitious kid until after his first semester in college, when he seemed to suffer an abrupt and troubling personality change that may have been related to drug taking on campus (this is reliable information form his friends, not a specious conclusion). The college mishandled the situation badly and cut us off from our son/nephew in the name of FERPA which we knew was a very wrong interpretation of the guidelines but without a battery of lawyers was impossible to fight. it’s so easy to blame the parents when you hear that a kid is having trouble. in this case you are sorely wrong, my sister and her husband did everything they could to help their son. to attack their character when she is only trying to reach out for information and assistance is cruel and frankly reflects the reflexively defensive attitude of the academic community that we have encountered at every turn. circling the wagons and blaming and even insulting the victim, in this case the parents of a teenager that is self-isolating and clearly needs help, is such a highly inappropriate reaction. I’m sure there is a more constructive way to conduct your forums.

Lia, at 8:50 am EDT on August 26, 2008