Overreacting to College Student Suicide?

Promoting reasonable expectations for suicide prevention will help everyone, write Paul D. Polychronis and Peter F. Lake.

May 16, 2018
 
 
Massachusetts Supreme Judicial Court

The suicide of Elizabeth Shin at the Massachusetts Institute of Technology in 2000, and the lawsuit that followed, prompted colleges and universities to engage in vigorous suicide-prevention efforts. That tragic event occurred in a period of time when higher education began to experience a significant uptick in students seeking and needing mental health care and interventions. Although few students who need care are either suicidal or violent -- and the combination is even more rare -- the mass shooting at Virginia Tech in 2007 cemented the need for colleges to address suicidality and its impacts.

Today, many colleges take comprehensive, science-based approaches to suicide prevention and integrate those efforts with larger campuswide risk-management efforts. Public cries for accountability, however, may be motivating colleges to overreact to the risks associated with student suicide.

Enthusiasm for preventing suicide can go too far with prevention campaigns that express the possibility that suicide is 100 percent preventable. In fact, such well-intentioned efforts can, ironically, be harmful, as they suggest that it is feasible that suicide can become a “never event.” But, sadly, despite best efforts, some suicides will always occur. As with other social problems, such as homicide and domestic violence, the hope for a complete eradication of suicide is noble but not realistic.

The Massachusetts Supreme Judicial Court just reinforced that perspective in a case involving another death by suicide at MIT. The court recognized that MIT had engaged in significant efforts to prevent the student’s death and acknowledged that some deaths by suicide are not preventable by institutions of higher education. The MIT case provides significant and meaningful guidance to institutions in their continuing efforts to prevent suicide -- but it also reminds us that best efforts may sometimes fail.

In science and practice, no empirical evidence supports the idea that all suicide can be prevented. The law has likewise been suspicious of the efficacy of suicide-prevention efforts. In earlier times, it assigned all legal responsibility to suicidal individuals and today imposes liability on institutions of higher education or on therapeutic professionals only infrequently and under very limited circumstances, as illustrated by the recent MIT case. Even inpatient units, seen as the most safe and secure treatment setting for acutely suicidal persons, are unable to completely prevent suicides from occurring. Prisons dealing with inmates who are suicidal can fail to prevent all suicides, as well.

Unfortunately, if those of us who work in higher education promise too much when it comes to suicide prevention, we risk producing a number of unintended negative consequences. Language in awareness campaigns that suggests all suicides can be prevented encourages people to believe that all suicides therefore ought to be prevented. Persons who struggle with suicidality and those who care for, and about, them can be lured to false hopes about the powers of the professionals to treat suicidal students. Some mental health practitioners now avoid working with suicidal clients for fear of being blamed for a death by suicide.

We must also consider professional ethics issues. If a psychologist were to assert that suicide can be completely eradicated, that position would be widely regarded as unethical. Psychologists are legally and ethically bound not to make exaggerated or unfounded claims of the effectiveness of their services or to misrepresent scientific knowledge. A campus that promises 100 percent suicide prevention risks putting the frontline staff in an ethical dilemma.

There are legal risks associated with overpromising, as well, including the risk that attempts to eliminate suicidality from the college environment might interfere with the rights of students entitled to protection from unlawful discrimination. For example, institutions might be tempted to seek to remove a suicidal student from campus without legally required individual assessment of a student’s rights to continue in a program or activity. And colleges may ultimately come to view suicidal students as costly potential legal adversaries rather than sufferers with whom helpers must try to collaborate.

Yet perhaps the most pernicious problem with messages that present suicide as completely preventable is the implication that when a suicide does occur it must be the result of some type of failure, neglect or negligence -- that a completed suicide always involves fault, and someone must be blamed. Well-meaning campaigns can be iatrogenic -- actually creating more risk for colleges by reinforcing a stereotype that suicide is inherently connected to wrongdoing.

The legal system is in part responsible for perpetuating the myth that suicide and fault are inherently connected. The law’s long-standing approach was that the suicidal individual was morally reprehensible and that attempting suicide was a crime. Today, defecting blame to others is only an evolution of primitive legal attitudes about suicidality -- perpetuating the stigma surrounding suicide and creating chilling impacts on intervention.

The fact is that the suicide by a person in treatment is not necessarily a failure on the part of mental health professionals or care teams. Yet when a death by suicide or even an attempt occurs, the people who have endeavored to assist a suicidal individual are likely to suffer guilt, self-blame and even despair. In most instances, those predictable responses occur with helpers who have done nothing wrong or legally indefensible. And a system that implicitly suggests that they have done so or are to blame could easily serve to accelerate their issues.

We have both observed this in our daily efforts as different types of suicide counselors. Suicidality has the effect of a grenade; it has a field of impact. Focusing on 100 percent suicide prevention potentially undermines wellness efforts directed to those people who are impacted by suicidality. A prime example: entirely blameless first responders to a death by suicide are often so overwhelmed with trauma and guilt that they may even consider suicide themselves.

We sometimes say colloquially that suicidality is contagious or magnetic; behind the colloquialism is the reality that guilt -- however irrational -- is a powerful feature of the complex set of causes related to suicidality. Modern prevention and intervention efforts must find ways to shred undeserved guilt and avoid any approaches that enhance the risk of the very thing we seek to prevent.

That is not to say that colleges and the administrators who deal with student suicides should not be fairly and reasonably accountable. Rather, we must move past thinking of suicide as a wrong, implying that every suicide must result in the imposition of blame.

Assertions that all suicides are preventable also convey an erroneous message to the individuals who struggle with suicidality, giving the impression that their own volition is less consequential and that an external person or organization can successfully control them. When suicide is successfully prevented, it almost always occurs with the collaboration and cooperation of the suicidal person. Perhaps the law’s traditional yet problematic view to blame suicidal individuals was a recognition, in some convoluted way, of the importance of personal agency in suicide prevention.

Our opportunity in higher education going forward is to enhance that agency, as opposed to recreating the blame game in a new form. Legally, that means searching for accountability approaches that improve rather than undermine our prevention and intervention efforts. From the perspective of the counseling center, that means listening to the best instincts of the people who are trained in this work.

Deaths by suicide can and do occur, even when everyone trying to prevent suicide demonstrates the utmost concern and compassion and the latest prevention and treatment methodologies. Intuitively, it may seem wrong to “accept” suicide as a campus reality. We should always strive to improve our prevention strategies. But we must use reasonable care with our aspirations. A fundamental standard of care in treating suicidal persons is to assist them in the least restrictive environment possible, which implies acknowledging that death by suicide may, in fact, happen.

Keeping suicidal students safe and well is difficult work and requires something other than pressure to attain an unrealistic goal of zero suicides. Instead, prevention campaigns should focus on counteracting stigma and encouraging students to seek help. Care and compassion should guide us, not the fear of assigning blame where none exists. Being realistic will place higher education in the best position to perform this challenging work.

The National Suicide Prevention Lifeline is a free, confidential 24-7 service that can provide people in suicidal crisis or emotional distress, or those around them, with support, information and local resources. 1-800-273-TALK (8255).

Bio

Paul D. Polychronis is a board-certified psychologist and director emeritus of the Counseling Center at University of Central Missouri. Peter F. Lake is a law professor and director of the Center for Excellence in Higher Education Law and Policy at Stetson University College of Law.

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