When to Tell

For counselors, knowing whether to inform parents that their child might be suicidal is hard, and -- following a handful of recent developments -- getting harder.

March 2, 2012

Deciding when it’s appropriate to notify the parents of a student who may be suicidal is already one of the more complex and consequential responsibilities with which college counselors must grapple. But with the recent emergence of several compounding factors that are already notable in their own right, this charge is becoming even more complicated.

Counselors report that more students than ever are entering college with severe psychological problems. Meanwhile, a federal rules shift has stripped officials of their ability to send home students who may pose a threat to him or herself, unless those individuals are at risk of harming others as well. Further, high-profile lawsuits are drawing attention to the fallout that can occur when colleges opt not to alert parents -- or don't realize they might need to -- and the student goes on to die by suicide, and legislation in at least one state designed to prevent such tragedies is upsetting counselors who fear that laws mandating parental notification are narrowly tailored, ill-informed and dangerous.

“I don’t think that in general there is a major likelihood of liability for an institution that does not notify a parent of the student’s mental condition. However, when circumstances permit, it can be a reasonable course of action for an institution to take,” said Ada Meloy, general counsel for the American Council on Education. “I think the idea that the institutions wrestle with each case is really kind of the meat of it here, and they have to deal with each situation of each student carefully. Because obviously, in these situations, the student is in a precarious position.”

Before the Justice Department revised the “direct threat” standard under Title II of the Americans with Disabilities Act late last year -- and in a departure from longstanding guidance from the Education Department’s Office for Civil Rights, declined to explicitly address what colleges can do when a student poses a threat only to him or herself, and not necessarily others -- colleges rarely forced students to withdraw for mental health reasons. (Though many worried that other institutions sometimes took advantage of the opportunity to get those students off campus). At the same time, counselors lamented that they no longer had the option.

The shift has caused a stir on campuses, and while counselors decide how to handle each case based on a slew of factors and circumstances, it could conceivably lead to more contact between parents and college officials.

“How do you manage chronically suicidal students on campus when you can’t force them to leave?” asked Brian Van Brunt, director of counseling and testing at Western Kentucky University, and a supporter of the recent rules change. “Why not involve the parents? Why not have a conversation with the student to try to get the parents on board to help?”

But, of course, it’s not always that simple. Students might not want their parents involved. And if that’s true, in most cases, unless the student is in the hospital or poses an imminent threat-to-self, state confidentiality laws leave counselors in a bind. (One exception is if a non-health official such as a dean or a behavioral intervention team referred a student to counseling in the first place, or became involved in the situation somewhere along the line. That’s how a case winds up on the student’s educational record, which if the student is at risk, would be accessible to parents under the Family Educational Rights and Privacy Act.)

Which is why officials who work with these students are wary about a state law that emerged after the April 2007 shooting at Virginia Tech University, which requires public colleges to notify parents if health officials believe a student might cause “serious physical harm” to anyone.

American Psychiatric Association guidance published after the law went into effect argued that parental notification should never be mandated, even when students’ health or safety could be at risk. “The nature of the student’s relationship with his or her parents needs to be explored and assessed prior to a decision about disclosure. These are common clinical judgments that often are made in emergency rooms and inpatient settings, requiring careful consideration in collaboration with the patient,” the document reads. “There has also been a worrisome tendency to overreact to recent campus tragedies by weakening confidentiality requirements and even mandating parental notification. These changes could have unintended deleterious impacts on the care of college students.”

“There is this push now to try and get parental notification, but I think it’s really shortsighted,” said Karen Bower, a lawyer who often defends students with mental health issues. “Fear of having their parents know is one of the reasons why students don’t get treatment. So enacting any kind of policy that discourages students from getting needed help is really wrong-headed.”

Mary-Jeanne Raleigh, director of counseling services at St. Mary’s College of Maryland, points to the inherent contradiction between such a law and a counselor’s duty to follow professional ethics code. If, for example, she knows the parent of a student she’s seeing is abusive, and notifying the parents is likely to make matters worse, how does she reconcile that with a law that requires her to make a telephone call?

“When you start to mandate something through law, it doesn’t allow for individual case issues,” said Raleigh, who is also president of the American College Counseling Association. Furthermore, who determines whether a student might be suicidal, and how? “That’s a pretty hard line, and can be tough to enforce,” she said, “and that’s where each school is going to be a little bit different.” It all depends on the size and availability of counseling staff, off-campus resources and referral options, and training of counselors, residence life and public safety staff -- not to mention individual perspective.

A settlement reached in December between Virginia Tech and the parents of Daniel Kim, who killed himself a few weeks after the university received a letter in 2007 from Kim’s acquaintance that speculated Kim might be suicidal, takes the state law even further. It required the university to adopt a policy whereby it must notify parents when there is any indication that a student may be suicidal. Kim’s parents had no idea about the letter or their son’s mental state, despite having spoken to him just a few days before.

Cornell University is facing litigation related to this issue as well. The father of student Bradley Ginsburg, the first in a succession of three students to jump to their deaths from a campus bridge over just a few weeks in early 2010, sued Cornell and the city of Ithaca, New York, for $180 million in November. Among the charges: the university should have notified students’ parents about three fall 2009 suicides, so they could conduct a “mental health check” of their children. The Cornell bridges have borne witness to dozens of suicides over the years -- and recently barriers were set up to prevent more.

Both lawsuits have been high-profile, and counseling centers are paying attention. But college officials shouldn’t need legislation or mandated policies to notify parents, experts say, nor should they be doing so only for fear of litigation.

"We do this all the time for more trivial things,” Van Brunt said, referring to conduct violations such as drug and alcohol use. “When it comes to suicide, there’s this weird place where often the deans or vice presidents of student affairs will push it off to the counseling center…. and then we clam up and we don’t find ways to notify the parents.

“If all we’re caring about is not to get sued, we’re never going to practice well.”

But the lawsuits also point to another truth that can make this judgment impossibly difficult: you can never know for sure what’s going on inside a person’s head.

“That’s why we always are pretty reluctant to speak out on any individual case, because everything we know from studying suicide is that people don’t have an absolute characteristic for harm,” said Ann Haas, programs director for the American Foundation for Suicide Prevention. “Not everyone who dies from a suicide looks depressed, acts depressed in the days or hours leading up to it. Many, many people who look very stressed and depressed don’t go on to die by suicide. So it’s not as clear as some people who may not work with suicide think that it may be. And I think that’s where we get into so much of the difficulty.”

The most recent iteration of the Association of American College Counseling Center Directors Annual Survey found that of the average 11.4 percent of students who seek counseling at a typical institution, 38 percent cite depression. Fifteen percent report struggling with suicidal thoughts or behavior.

Haas, who works with colleges on interactive screening programs that counseling centers use to flag potentially at-risk students, said that if there’s one thing campuses can take away from these lawsuits, it’s the importance of clear guidelines of what behaviors or gestures warrant parental notification.

“The question I think that everybody struggles with is, where’s that line between a young person who is in charge of their own treatment and their own choices and how do you make that judgment call about when the family will be a support in any given case as opposed to really disrupting the treatment that the young person’s in,” Haas said. “There’s many different interests they’re trying to serve, and one of those is the student’s best interests. Trying to differentiate that from the family’s best interests, and then from the school’s legal responsibility, and then the potential that they will be judged and blamed afterwards – I mean, it’s a very complicated kind of mix.”

But as questions of parental notification continue to plague college health, perhaps more than ever, it’s critical that officials don’t get wrapped up in policies, mandates and blame, Haas said, and risk forgetting that everyone really wants the same thing.

“The thing that we are most invested in is trying to find solutions that will really help people as we move forward with this and not be looking backwards with all of the pain that goes into the aftermath of the suicide,” Haas said. “We’ve got to find more and better ways of reaching these students before the fact.”


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