The author of a new book on student suicide says colleges need to think about a lot more than liability
Gary Pavela was a head resident at the University of Illinois at Urbana-Champaign when a 19-year-old student jumped from a 10th-floor dormitory window. Mr. Pavela rode with the student, “WR,” in the back of an ambulance, not knowing that he was already dead.
Later, Mr. Pavela assembled some of the comments WR had written in the margins of notebooks. “Help, I’m scared,” the student had written in his chemistry notes. “I don’t want to lose.” Mr. Pavela filed the materials away for more than 20 years. He dug them out after recent lawsuits arising from student suicides stoked liability concerns throughout academe. WR’s scrawls, Mr. Pavela says, are a reminder of the human components beneath the legal controversies.
Recently, The Chronicle asked Mr. Pavela, director of judicial programs at the University of Maryland at College Park, to discuss some of the issues he explores in his new book Questions and Answers on College Student Suicide: A Law and Policy Perspective (College Administration Publications), which is scheduled for release in June.
Q. What is the biggest misconception about suicide among college students, and how did it develop?
A. The biggest misconception is that we should be looking at student suicide primarily from a risk-management perspective. We, college administrators, have understandably been paying a lot of attention to what this case means, what that case means. Our responses to students become defined by the lens of the law and not through our primary responsibility as educators. As educators, we have to take some risks. That means working harder to keep students at risk of suicide enrolled, working with them, giving them the help they need, and not finding faster and more creative ways to remove them.
Q. So, as you see it, helping depressed students cope is part of a college’s educational mission?
A. There is good research on a correlation between some mood disorders and higher rates of creativity. We’re not talking about someone who’s in the depths of clinical depression, but it appears to be educationally unwise to quickly dismiss folks who could be some of the most thoughtful people in our schools. And even a lot of college administrators do not realize that the rate of young-adult suicide for people going to college is about one-half of the rate for young adults who are not going to college. We get caught up in all the publicity about college-student suicide and don’t realize that our environment may be sort of protective.
Q. How so?
A. We know one of the primary means that people use to kill themselves is firearms. We do a good job on college campuses of limiting firearms. When we dismiss someone, we are taking someone out of an environment that is protective and putting them in an environment where they are more likely to harm themselves.
Q. A former student at George Washington University, who was dismissed because of his depression, is suing the institution, claiming that his suspension violated the Americans With Disabilities Act. Does that case suggest that mandatory-removal policies carry legal risks of their own?
A. Yes. I have seen a significant resurgence in these policies. It is very clearly a risk-management approach. But what has stunned me is the lack of attention to the fact that there is something called the Office for Civil Rights within the U.S. Department of Education, which has been called upon to issue letter rulings pertaining to these policies. It is amazing how little attention has been paid to that by college and university lawyers. The GW case is a warning. If you live by risk management, you can die by risk management.
Q. In the wake of recent court rulings, it seems there is a lot of confusion about what the law says about legal liability for student suicides. What would you say to reassure administrators that the risk of liability for suicides is, as you say, low?
A. There is a convergence of good practice and what the current state of law actually is. At most, cases that have gone against colleges were addressing the circumstance when a student was at imminent risk of suicide, there were repeated threats, and no ambiguity about the high risk that student posed. Therefore, we can learn from the cases and from what mental-health professionals are telling us: We, as college administrators, have erred on the side of underreaction, in terms of notifying parents, in terms of hospitalization, in terms of therapeutic resources. These narrow, modest holdings in some recent cases do not define the law nationally and do not mean your proper response as an administrator is to find a quick way to get rid of the student. What the cases would point to is that you must react promptly and appropriately to a student who is manifesting signs of imminent risk of suicide.
Q. What does it mean to act appropriately?
A. Actually, it’s fairly simple. Get the student into the mental and observational treatment they need. Work with them as part of a team with mental-health professionals and work to find ways to keep the student enrolled. That is more protective of them and, ultimately, of us.
Q. In your book, you discuss the growing concerns about “fragmented care,” where students may receive treatment from numerous therapists. What are the implications of this issue in academe?
A. It’s becoming a national medical-liability issue, and this problem is most pronounced at colleges with the most resources, those with the largest number of psychologists and psychiatrists. On paper, it might look like they’ve got a great program, but they have to be attentive to this evolving issue of the importance of having a central case manager dealing with each student. I would urge colleges to be more creative and client-centered in the use of these resources to minimize the problem. It’s a bit of a canary in a mine shaft, a warning about the general depersonalization that occurs on large campuses, with many staff members seeing different students at different times. Someone at the administrative point and at the medical point needs to be the equivalent of a mentor, a consistent responder to that student.
Q. You write that there has been a “seismic shift” in terms of how colleges view parents. How does that relate to preventing student suicide?
A. In the past, there was a strong ideological bias not to notify parents about problems a student was having. But five to 10 years ago, we saw that seismic shift toward more parental notification. We had Ferpa [Family Educational Rights and Privacy Act] amended; we are able to notify parents in certain alcohol incidents. There’s much more of an inclination toward parental notification.
Q. And is that a good thing for parents and colleges?
A. One of the reasons why parents feel that they need more information about what is happening to their children on campus is, in part, precisely because parents are aware of this issue of the fragmentation on college campuses. Helicopter parents may irritate us, but they may be on to something. Part of it is the wisdom to understand that when they send their kid off to this 20,000-person campus, they’re not going to get a lot of attention, and they’re going to have a lot of stress.
Q. In the case of a potentially suicidal student, who should notify parents and under what conditions?
A. Mental-health professionals will have a legal and ethical obligation to breach confidentiality in an emergency, when a person is at imminent risk of harming themselves. Parents would have to be notified by the hospital. When students enroll, it should be part of their file: Who do you want notified in case of emergency?
Q. And what is the role of an administrator?
A. There is a lot of hand-wringing about letting parents know if a student is having a problem, but administrators have more latitude than mental-health professionals to notify parents. If I’m a college administrator and a student is talking about suicide, I’m going to err on the side of treating that as a genuine suicide threat or gesture, arrange for immediate evaluation of that student, ask the student about needing to involve the parents immediately, listen to arguments about why that wouldn’t work, and I would talk to a mental-health professional. But my standard position, once there is a suicide threat or gesture, is to notify parents, even when it isn’t a full-blown emergency. I would rather have the student mad at me about that, than have that student dead.
Q. You make a distinction between “hair-trigger” removal policies for suicidal students and policies that use the threat of removal as “leverage” to get students help they need.
A. A suicidal student needs to hear the message that threatening words or gestures are unacceptable. This can be done in a way that is not abrasive, telling a student that we are a community that can’t tolerate violence, including violence to self, and we have a mechanism to help you, and if not, we can remove you. You are using the administrative process as a lever to get the help the student needs and keep him on campus, which is dramatically different from the hair-trigger approach. Both are using discipline as a threat, but one is carrying through immediately, and the other is doing everything possible not to use it.
Q. What can colleges do to empower students to help prevent suicides among their peers?
A. One of the biggest things to come out of research, including research into the Columbine case, is how often peers know about a high risk of violence. So there ought to be more discussion with students about what friendship means. Colleges ought to engage students in a discussion that says that at some point, loyalty means not loyalty in its most simplistic sense, but the loyalty to save a person’s life, literally. Someone has got to pull the friend out of that spiral, out of the disoriented thinking that keeps bringing him downward. I think we need a variation of “friends don’t let friends drive drunk.” Friends don’t let depressed students handle their problem alone, and they get help for that student, even if they have to break confidentiality, just like they would take the car keys.
Q. Should colleges encourage faculty members to reach out to depressed students? And how should that happen?
A. Administrators need to give faculty members some immediate advice not to underreact. If you encounter a suicide reference in a paper, at a minimum you need to talk to the student and figure out what the student is alluding to. If there’s any concern, err on the side of overreaction, but by overreaction, I mean getting professional help to the student. It would be a mistake for the professor to say, “I will simply pay more attention to the student.” Friendship alone will not address it.
Q. You also believe mentoring can help students feel less isolated?
A. I do think we need to pay more attention to revitalizing mentorship, not as a treatment for depression but as one component. The rate of students telling us they need help for depression appears to be off the charts. One of the triggering factors to depression is isolation, the feeling of not being a part of a community. Professors have a role here in learning what these high rates of depression are telling us, that something is maybe breaking down in our communities, and students don’t feel they have someone they can confide in, particularly an adult.
Q. Initiating discussions of suicide seems tricky for colleges. It’s not like you can advertise an ice-cream social where suicide and mental health will be discussed. What are some strategies for getting students to talk about the issue and learn about mental-health resources without scaring them away?
A. The approach that might make more sense is to hold a stress-management seminar. You’re going to get a big turnout for that. Another is to talk about relationships. One thing I discovered that surprised me is the high correlation between intimate-relationship problems and youth suicide. About 50 percent of youth suicides are related to intimate-relationship problems. So if you talk about stress management, and you talk about relationships, inevitably, the topic of suicide ought to come up, and we ought to bring it up.
http://chronicle.com Section: Students Volume 52, Issue 37, Page A39
