(American Foundation for Suicide Prevention - AFSP, 2011),  and is often the result of

depression, substance abuse and conduct disorders. According to the American Foundation for

Suicide Prevention, 38,364 suicides were reported in the United States in 2010, equating to a

death by suicide every 13.7 minutes.  

Epidemiologically, a literature review reveals three (3) groups of factors that may impact upon suicidal ideation or attempt at suicide: health factors, environmental, and historical factors play an important role. Health factors related to mental health conditions may include depression, bipolar disorder, schizophrenia, borderline or antisocial personality disorder, conduct disorder, psychotic disorders, or psychotic symptoms in the context of any disorder, anxiety disorders,

substance abuse disorder, serious or chronic health condition and/or pain, which may contribute to the first group of factors related to suicide. Environmental factors comprise the second group.

These include stressful life events; for example, death, divorce, or job loss; prolonged stress

factors which may include harassment, bullying, relationship problems, and unemployment;

access to lethal means including firearms; drugs; and exposure to another person’s suicide.

Finally, historical factors that include previous suicide attempts, a family history of suicide attempts, correspond to the third group of factors that could impact upon the rate of suicide (Applelbaum, 2006; Martin, 2017; and Wei, 2008).

Given the complexity of factors that influence student suicide, colleges and universities must implement the most effective prevention efforts for their students’ well-being and protection. Suicide Prevention Programs provide a resource for students who may feel that they have nowhere else to go when such issues arise. College and university campuses are the most accessible point of contact for young adults at risk for suicide, and thus are a natural settings for suicide prevention activities that may have the most influential impact.

According to Martin (2017), mental illness, especially self-harming behaviors, is

considered to be a crescent issue between college and university students. This author mentions

that schools generally apply protective procedures for these students, such as suspension,

withdrawal from courses or placement on leave, that carries a complex and obscure process of

readmission. In fact, these policies, which seems protective on the surface, facilitates discrete

discrimination and therefore, make it difficult for students who may seek treatment. The author

offers a closer analysis of the policy implications related to the dismissal of students in the name

of their personal safety, when the possible goal may be one that serves the institutions first and

foremost.  Fear of liability is one factor.  Technically, this endangers those who most need help. 

In conclusion, Martin (2017) suggests clarifying the question of liability; setting

boundaries on a school’s actual liability; and liberating those schools from liability when a

student suicide occurs. Could this be the avenue to make progress on such a sensitive issue with

life or death consequences? Even though it would seem to be against a student’s or their families

best interest, the author affirms that it would eliminate the concern of liability and encourage a

joint targeted effort in developing an innovative and embracing coping strategy.

Our project aims to analyze existing preventive policies in a few State Colleges, in

Central Florida to better delineate differences and their effectiveness.

 

In educational institutions, American Tort Law’s evolution and dominance in the Legal System in the United States, shows that Common Law does not recognize the duty of a university and an adult student “absent of showing of a special relationship.” (Emory Law Journal, 2008).

The issue of “foreseeability” has played a role where litigation has created an environment that places universities in the crosshairs of lawsuits.  This is the notion where a university is said to assume a responsibility in seeing in advance the risks posed to the student who may be suicidal.

The reality is this has forced higher educational institutions to automatically take the least risky path by asking the student to withdraw from the institution immediately at the first hint of exhibiting suicidal tendencies, real or not..

Case law in the United States has played  a major influence.  Case law further demonstrates that in the United States, the courts, legislatures and universities have all been at the forefront of a health epidemic instead of mental health professionals guiding possible solutions, which would seem the more prudent path for any long-term solution.  In 2004, for example, a college student went to a hospital simply seeking treatment while the males was a student at George Washington University.  Once the University learned of this, the student was asked to withdraw immediately.  The consequences were noted to be severe and the student was even barred from campus property.  The student had committed no crime. The resulting lawsuit, Nott v. George Washington University (D.C. Super Ct., October 25, 2005) took two years to resolve which culminated in an early settlement out of court. Even though the Nott student was on medication, and it was originally his concern about the medications he was taking that might lead to suicidal thoughts, the university, once it learned about the matter, asked the student to withdraw.

Another case, the Jain v. State case in 2000, the ruling favored the university institution. The ruling by the Iowa Supreme Court said the university did not increase the probability of the student actually committing suicide. It also affirmed the general principle that suicide is a superseeding condition (Emory Law Journal, p.655).

Another case which has played a role historically is the Shin case, where an MIT female student self-immolated and eventually was taken off life support by her family. Subsequent lawsuits cleared the university of any wrong-doing but made administrators personally liable, as they were closer to the student in question. (Shin v. Massachusetts Institute of Technology, Massachusetts Superior Court, 2005).

The case of of Schieszler v. Ferrum College, is another  example within the courts that further  compounds the legal landscape.  In this case a special relationship is found. Further, the college is found to have a duty to the student in question. Because the university was knowledgeable of the student being at risk of harming himself, this duty was established by the plaintiffs. (Schieszler v Ferrum College, 236 F. Supp. 2d. 602 (W.D. Va. 2002).

The pendulum then swung back to reduce the liability of administrators. In an Allegheny College case where a student expressed, prior to his own suicide, his suicidal tendencies, the pretrial ruling was such that the administrators were not found to be responsible. (Mahoney v Allegheny College, Pa. Ct. of Comm. Pl., Dec. 22, 2005).

In all of these historical cases, the legal system is prepared to serve notice. Confusing as it may be, law suits are awaiting administrators and institutions at each turn, whether they find themselves with a student who commits suicide or whether they just ask a student to leave the institution because the student is at risk of suicide. The dominance of American Tort Law is manifested in this problematic health issue facing students who desperately need compassionate care. Because compassion is not traditionally a description attributed to the American judicial system, students who are at risk of suicide are simply left to their own measures. Universities and colleges who wish to keep their reputations intact and the reputations of their staff pristine, will in all likelihood choose the path of least resistance, which is to remove the problem at hand. In this case, the student is asked to immediately withdraw from the institution.  The student has technically become persona non grata.

Studying suicide as a point of law is important in higher education because institutions are left to deal with a variety of issues when such incidents occur. In particular, the Office of the Dean of Students, Residence Life, and Counseling Centers take on the dominant role because the nature of their involvement with students tends to be more personal when compared to other offices (The JED Foundation, 2015). In the absence of a consensus regarding to the best practices to prevent suicidal behavior, counseling centers appear to be doing an extraordinary job reducing suicide among those students who seek services from them.  Counseling service clinicians are the first line of care for students struggling with serious mental health concerns, which may entail risk for suicide. Counseling clinicians are also frequently in the lead in directing management of campus suicide attempts and campus suicide (Schwartz, 2011).

According to Reed and Shea (2011), when college students find themselves in the company of a college counselor, they may adopt a hesitant posture to openly share suicidal ideation and intent. The same authors suggest that “the first rule of life is to seek help when help is needed, whether for oneself or others” (221).   Best and evidence-based suicide prevention practices; risk factors and warning signs for college and university students; how to assess young adults at risk; confidentiality; prevention and postvention principles; self-injury; how to integrate a student after a suicide attempt; and dealing with traumatic loss and mental health problems, are suggestions that many college mental health providers offer when designing effective suicide prevention programs. (Drum & Denmark, 2011).  The authors maintain that some prevention efforts fail to have any effect, because they are “underdosed” and rely on one or a few isolated interventions.

General awareness of warning signs of depression, early identification of high-risk students, detailed and well disseminated university policies about how to handle at-risk students and situations, and ready access to psychological and psychiatric care are universal recommendations. Warning signs, prevention, and intervention-focused information should be made available to resident assistants, staff, and counselors who are involved with the protection and care of college students.  

According to Kern (2015), Students at colleges and universities are a difficult population to monitor, and it is not easy to target interventions, and courts have traditionally held that suicide is a “deliberate, intentional and intervening act that precluded another’s responsibility for the harm” (225). Exceptions to this general rule, however, have become more prevalent, particularly in two specific cases: “where the individual or entity actually caused the suicide”; and “when the individual or entity had a duty to prevent the suicide” (225). Courts in the United States have overwhelmingly freed colleges and universities from liability for student suicide, finding that the schools neither caused the suicide nor had a special duty to prevent the suicide. However, two cases, Schieszler v. Ferrum College (2002), and Shin v. Massachusetts Institute of Technology (2005) have caused concern for the higher education community. These cases suggested that the court may find that a special relationship exists and therefore hold schools liable for student suicide in the future. 

 

Asha- §14.2019. Statewide Office for Suicide Prevention: (1) The Statewide Office for Suicide Prevention is created within the Department of Children and Family Services. (2) The statewide office shall, within available resources: (a) Develop a network of community-based programs to improve suicide prevention initiatives. The network shall identify and work to eliminate barriers to providing suicide prevention services to individuals who are at risk of suicide. The network shall consist of stakeholders advocating suicide prevention, including, but not limited to, not-for-profit suicide prevention organizations, faith based suicide prevention organizations, law enforcement agencies, first responders to emergency calls, suicide prevention community coalitions, schools and universities, mental health agencies, substance abuse treatment agencies, health care providers, and school personnel. (b) Prepare and implement the statewide plan with the advice of the Suicide Prevention Coordinating Council. (c) Increase public awareness concerning topics relating to suicide prevention. (d) Coordinate education and training curricula in suicide prevention efforts for law enforcement personnel, first responders to emergency calls, health care providers, school employees, and other persons who may have contact with persons at risk of suicide (afsp.org). 

Valencia is a state college located at Orlando, in Florida. The college was founded in 1967 and has undergone several appraisals and development and now is one of the best colleges in the region. Our focus is on the health policies set by the college to ensure that students are assisted during health and mental distress. The health policies and the procedures laid down to help students vent out personal issues which could trigger depression or suicidal thoughts are some of the key issues which will be largely focused on. How the school addresses students who require special medical attention, as well as those of special needs. The medical records on the same will be highlighted and any supporting information relevant to health policies will also be discussed.

Gregg Henriques, a professor of Philosophy, asserts that the students show greater levels of stress, anxiety, depression, eating disorders, and poor sleeping patterns. This pattern continues to be on rise and is a great threat to students’ life in college, if not well handled or controlled. In bid to explain the causes of these factors, the professor notes that, it is as a result of combined societal and institutional factors. According to mental health research conducted by the National Alliance on Mental illness (NAMI), one in every four students have diagnosable illness, 40% do not seek medical attention,80% feel highly overwhelmed by responsibilities, and 50% are in anxiety. Influence of drugs and addiction of the same has also been identified as well as one of the causes of mental illness among students.

The institution has Ombudsman page which allows the students to report cases of violation of their rights. This page allows the students to raise concerns over their grades, (grades dispute),complaints over administration, civil rights discrimination, sexual harassment, and any form of violation on expected students’ code of conduct. The policy (6Hx28: 8-10) “Student Academic Dispute and Administrative Complaint Resolution”, is meant to help the students raise their concerns about the administration and issues affecting their academics. This policy was effected on December 2015 and seeks to assist students, where their rights are violated or infringed upon, instead of just going quiet or dump on genuine concerns. The school then listens to the students’ complaints, accesses the situation before applying appropriate remedy, which is fair not only to the students, but also to the administration itself.

The college also holds suicide prevention week events, which are supposed to enlighten students against suicide, and importantly discuss with the students on the importance of seeking assistance before contemplating on self-destruction. The event is usually scheduled on Monday at 9.00 A.M.

In addition, the team will contact the Dean of Student Services, who the group has identified, to better understand Polk State College’s approach. This meeting will take place in April.

Interviews Held: An Interview was held through the Zoom software tool with the Dean of Student Services at Polk State College, on Tuesday, April 17, 2018, at 2:00pm.  Larry Pakowski was able to work from a list of questions the team had prepared in advance for him.  This list of questions follows. 

The subject of suicide prevention is an area that is a component of the disabilities  and mental health program to assist students at Polk State College.  It is one example of a higher education institution in Florida, with a sizeable student population, addressing this important health and safety issue.

Below are the questions used to generate a discussion with the Dean of Student 

Polk State College, on Tuesday, April 17, 2018.

The meeting’s results are found follow from these questions.

Dean Pakowski would say that developing more information materials and outreach materials 

1.     Best and evidence-based suicide prevention practices; Risk factors and warning signs for college and university students; How to assess young adults at risk; Confidentiality; Prevention and postvention principles; Self-injury; How to integrate a student after a suicide attempt; and Dealing with traumatic loss and mental health problems. -The University of South Florida Offered the Suicide Issues in Behavioral Healthcare undergraduate course Presented Suicide Prevention – Awareness and Action: What to look for, what to do, & how to help.

-College of Central Florida’s Suicide Prevention Initiative provides education and awareness on signs-and-symptoms, interventions, and resources. - University of South Florida offered Campus Connect: Gatekeeper Training for Suicide Prevention

- University of Central Florida’s Healthy Knights 2020 initiative promotes wellness and help-seeking of students and provides specific outreach to vulnerable students though a Campus Suicide Prevention grant

Student’s Grade……………………………………

Date ……………………………………………………

1.       Have you ever thought of committing suicide?

a)      Yes

b)      No

c)       Sometimes

2.       How often have you thought about killing yourself in the past years?

a)      Often

b)      Rarely

c)       Sometimes

d)      Never

3.       Have you ever told someone that you want to commit suicide?

a)      Yes

b)      No

c)       Never

4.       How is it likely that you will commit suicide?

a)      Never

b)      In the foreseeable future

c)       Not sure

5.       Has any of your friends in the college committed suicide?

a)      Yes

b)      No

c)       Not sure

 6.       How often do you think the students are likely to commit suicide?

a)      Often

b)      Less often

Creative approaches being considered at the moment, locally in Central Florida, include the following:

Idea | Target Population | Where Considered
“Develop Success Coaches” | Incoming Freshman | Polk State College
Increase Number of Advisors | Freshman to Senior | Polk State College

As licensed clinical worker Theresa Ngyuen says, parents and guardians must communicate openly with..”teens.” (Bouhknigt, D., The Ledger, April 19, 2018).

“If you don’t talk to them, they will turn to the internet, phone and social media, where they may experience bullying and misinformation.” (Nguyen, 2018).  Nguyen compares suicide talk to sex talk.  “You can’t just ask, “Do you know about sex?” “They reply, ‘Yes,’.”  Then the parent says ok, and they are done with the discussion.

The creative discussions that must take place with young adolescents has to begin quite early.

Some creative steps, suggested by Nguyen, who is vice president of policy and programs at Mental Health America (mentalhealthamerica.net),  include the following:

Themes to Consider | Ask: | 
 | 

Identification | Is there fear? | Is there discomfort? | Is there anxiety?
Conversation | Be direct | Empathy Wins | What is the struggle?
Create Time | Set critical time aside | Never rush | Be flexible
Modeling | Make the environment | Never pressure | Go First
Autonomy  | Create space | No over-reacting | Emphasis on respect

Such suggestions by Nguyen highlight the challenges faced by adolescents confronting the challenges of modern society today and as they embark to college.  Nguyen believes the rise in suicide ideation and completions have increased. With the year 2012 in mind, it is the year that smartphone ownership was registered to be greater than those who did not own a smartphone. This fact can perhaps be attributed, according to Ngyuen, to the rise in isolation and lack of deep relationships that exist today between individuals.  When face to face interaction was often the rule, today, the level of isolation among adolescents has become even greater. Such isolation has bred an environment where counselors are clearly on the front lines and observing youth who are ill-equipped socially for handling the rigors of college life.

Creative solutions that bring out campus mental health and suicide discussion out in the open benefits everyone in any educational setting today, not only the student at risk.

With colleges and universities facing potential liability, or imminent risk of the school being labeled as a “suicide school” and the negative publicity that comes along with it, mandatory withdrawal policies appear to be a common reaction to some administrators (Baker, 2005; Applelbaum, 2006; & Martin, 2017). However, this kind of “solution” has generating discomfort between educators and mental health professionals, since it takes care of institutions and their reputation, while the primary focus, that would be the student, would be misled (Martin, 2017). For the administrators charged with the duty of supervising the education and safety of the young adults it becomes a necessity to have available an established policy to address this student that encounters himself/herself in emotional turmoil without harming universities (Majewski & Mallett, 2012).

According to Lamis, Underwood & D'Amore (2017), the importance of working together (school personnel, researchers, mental health providers, and policy makers) is evident to "establish prevention programs that successfully reduce the incidence of suicidality" (p. 97). In this direction, universities could be more effective, providing mandate counseling treatment or training in problem solving to troubled students, without promoting the false idea that they are totally responsible for prevent things that are beyond their control (Joffe, 2006). Additionally, discussing the limits for litigation could also facilitate the action of the school personnel, without fear of liability (Martin, 2017). 

It is imperative that university personnel be able to recognize the behaviors or symptoms associated with suicide risk and mental health disorders so they can then encourage students exhibiting those signs to seek help (Farrell, et al.). Gatekeeper training programs equip participants with the knowledge and skills to identify and respond appropriately to the warning signs for suicide, which includes referring students displaying those warning signs for services. 

Although the suicide literature has many suicide training models, protocols, policies, and general recommendations, they failed to identify a comprehensive empirically supported suicide training model efficient to non-mental health professionals. When they are found, they occur basically in mental health graduate programs.

Another important aspect is that the majority of colleges does not have a clear policy mandating that deans or others administrators tell a medical professional of suicide threats that could come to their attention. Administrators in general are prone to trust in their judgment based in their experience. However, research shows that higher education administrators have not been trained to handle emotional or mental health problems properly. To recognize the necessity for communication among the branches of their institutions can be important action to prevent suicide, holding interdepartmental meetings to discuss students who could be a threat to themselves.

The success of any program or preventive policy, would involve developing a non-discriminatory, non-punitive approach to students in crises because of mental health problems.  Replacing mandatory withdrawal policies with a readily accessible leave of absence system; establishing  a formal training program for school faculty and staff ; increasing the behavioral intervention and assessment teams; repriorizing funds and resources available at counselings centers and disability services; developing integrated systems to reduce stigma on a systematic level; developing parent notice policy; and broadening the understanding of the legal precedents, would help to address the issue of student suicide with compromises and proactivity (Applelbaum,  2006; Martin, 2017; Lester,2013).

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Webpages American Foundation for Suicide Prevention -  AFSP - https://afsp.org

WCP-Work Group 3 padlet: https://padlet.com/gmatisz/e6tco7oqtsdg