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1 College Can Be Killing: United States College and University Responses to Student Suicide During the 20th Century and Early 21st Century by Peggy Brandt Brown

2 If you or someone you know is thinking about suicide, contact the National Suicide Prevention Lifeline at TALK ( ). In the United States during the latter 20th Century and early 21st Century, suicide was the third leading cause of death among youth ages 15 to 24. Responses of American colleges and universities to student suicide evolved over that period. At one time, the academic community denied suicide was a problem for their students. The 1978 PBS broadcast College Can Be Killing was influential in changing the way the event of a college student s suicide was managed on American campuses. As the century progressed, admission and student affairs staff, both as individuals and professions, began to recognize the reality of student suicide and started combating a denial of suicide as a problem on American college and university campuses. In the 21st Century, the development of computer technology and the Internet made a difference. Main issues were liability, written protocols and plans, parent notification, mandatory counseling and/or withdrawal, and limitations of access to the means to kill one s self. Suicides at colleges and universities in the US have been a concern of campus student affairs administrators 1 and chief executive officers. Sandeen (1991) stated that a good deal of student affairs leaders time is spent dealing with crises. The first crisis he mentioned was suicide. Each suicide could bring untold, negative publicity to an institution. If the failure of a student to attain a degree could be considered to be an institutional failure, how much more was a suicide on campus? The responses of American colleges and universities to student suicides have changed over time. Once, student suicide was considered to be a national problem, but not one at local campuses (Hendrickson and Cameron 1975). During in the 1980s, institutions became more proactive in training student affairs, health services, counseling, and housing staffs to address issues related to the prevention of suicides (Jobes et al. 1997). One of the markers of the change was a suicide that occurred at Northwestern University (IL) in Chicago in 1977 and was featured in a Public Broadcasting System (PBS) special, College Can Be Killing (Hirsh 1978). In this study, the broadcast was used as a point from which to examine changes in how the event of a student s suicide was managed on college and university campuses in the US during the 20th Century and as the US moved into the 21st Century. Three lawsuits against colleges and universities by parents of students who committed suicide and the number of mass killings in the US were the markers of change at the beginning of the 21st Century. According to the US Centers for Disease Control and Prevention (CDC), during the late 20th Century in the US, suicide was the third leading cause of death among youth ages 15 to 24, a statistical grouping that includes traditional college student ages (Kachur et al. 1995). Suicide was exceeded only by unintentional injury and homicide for this age group. Despite the stability of the national suicide rate over recent decades, rates for teens and young adults increased dramatically from 1950 to 1990, (Kachur et al., 17) from 4.5 suicides per 100,000 to 13.5 per 100,000 for persons years of age. CDC reported persons under age 25 accounted for 15 percent of all suicides in 1992 and that year, more young people from 15 to 24 years old died from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined. Campus student suicides arouse much public interest and concern because the act itself is perceived to be a rejection of all that university life strives to be for bright and ambitious young adults (Silverman 1993, 330). The problem of suicide was a part of college and university life. The act of suicide disrupted normal campus life (Silverman) and had a ripple effect throughout the institution (Pruett 1990). Students, faculty and staff questioned what they could have done to have prevented the suicide (Hipple, Cimbolic and Peterson 1980). Media attention was focused on the campus (Hipple) and questions were raised about the mission of winter 2014 JOURNAL OF COLLEGE ADMISSION 35

3 the school and how that mission was being fulfilled (Silverman). Families of the victims (Jamison 1999) and parents of other students wondered how the death could have happened, whether their own children were at risk, and what the school was doing to keep the surviving students safe (Rickgarn 1994). To understand how the responses of colleges and universities changed during the 20th and 21st Centuries, literature relating to the event of a college student s suicide in the US was reviewed. The Educational Resource Information Center (ERIC) database was searched, as were the databases for the American Association of Suicidology, the National Library of Medicine, the National Institute of Mental Health (NIMH), The Jed Foundation, and the larger college and university professional organizations. Internet searches of college and university websites were conducted. Additionally, a copy of the PBS broadcast College Can Be Killing (Hirsh 1978) was reviewed. Interviews were conducted with several practicing student affairs professionals in the US. This study is concerned with how colleges and universities in the US responded to student suicides and how those responses evolved during the 20th Century and are dealt with today. Some limitations to this study are that the literature made no distinctions between full- and part-time students. Rarely mentioned was whether the college studied was a two- or four-year institution. The epidemiology of student suicides or the psychological, social or medical reasons students end their lives are not examined. 2 Comparisons of suicide treatment and prevention programs and the various elements and achievements of such programs on campuses are not addressed in this study. 3 During the Early 20th Century One of the earliest comprehensive studies about people killing themselves was in 1857 (Durkheim 1857, trans. 1951) and one of the first known analyses of student suicide in the US was published in 1928 by R.S. Cavan. In January and February of 1927, 20 student suicides occurred in US colleges and secondary schools, so many that newspapers and periodicals considered the phenomenon to be a suicide wave or epidemic (Cavan 1928, 263). Cavan declared the cases were treated with a great deal of hyperbole by the daily papers with spectacular headlines and full column accounts on front pages often with a summary of all preceding cases. After a brief analysis, Cavan concluded student suicides were not taking place at a rate far removed from the norm for that age group. In response to the 1927 events, the first study of suicide on American college campuses was published in 1932 (Slimak 1990). One of the first studies of student suicide on a single campus was undertaken after five suicides happened at the University of Michigan in 1934 (Raphael, Power and Berridge 1937). The study was concerned with why the students killed themselves, and did not discuss the prevention of suicides or how the school should respond to such an event in the future. During and immediately after World War II, there was a hiatus in the study of suicides at American colleges and universities (Slimak 1990). During the 1960s and 1970s By the early 1970s, numerous studies had been done on the rates, reasons and characteristics of college students who attempted or completed suicide (Temby 1961; Braaten and Darling 1962; Bruyn and Seiden 1965; Seiden 1966; Peck and Schrut 1971; Mishara, B.L., Baker and Mishara, T.T. 1976). However, responses of colleges and universities to such events were not mentioned until Hendrickson and Cameron s 1975 study of a random sample of 90 deans of students at two and four-year colleges and universities. The researchers found: A serious gap was evidenced by the deans of students between their perception of the problem of suicide on their home campuses, and the realities of the situation (352) Significantly fewer administrators perceived student suicide as a local compared to a national problem, and their recognition of suicide on their campuses was significantly lower than state data would suggest implementation of [suicide] preventive measures on home campuses was minimal (354). This same lack of attention was seen in several of the texts and handbooks relating to student affairs and counseling of the time. In Student Personnel Services in Higher Education (Shaffer and Martinson 1966), student suicide was not addressed in the chapters on counseling, mental health or housing. In The Counseling of College Students (Seigel 1968), suicide was mentioned four times, three times as parts of statistical lists and once in one paragraph written on the characteristics of suicidal students. That paragraph began with Few suicidal cases were reported (28). The Counseling Center in Higher Education (Gallagher and Demos 1970) had a brief but meaningful description of how the psychiatric consultant was to deal with suicidal students although the term depressed was used much more than suicidal. In a book for residence hall staff published in 1969, out of 215 pages, only three short paragraphs were devoted to how to recognize and deal with suicide threats and attempts (Powell et al. 1969). The approach appearing frequently in the literature and that seemed to be the standard way colleges or universities responded to suicide attempts or threats was watchful waiting and hospitalization 36 winter 2014 JOURNAL OF COLLEGE ADMISSION

4 (Raphael et al. 1937; Temby 1961; Ross 1969; Grollman 1971; Baker, H.S. 1978). Temby recommended that if a suicide attempt or threat was made, there is an excuse to call someone, policeman or doctor, who can arrange to have the person taken where he [sic] can be treated or hospitalized immediately. But short of an actual attempt or threat, the course may have to be one of watchful and tactful waiting (150). The National Institute of Mental Health (NIMH) Center for Studies of Suicide Prevention was established in 1966 and stimulated interest in the subject of suicide (Seiden 1971). By the 1970s, suicide prevention centers began to develop in communities across the US (Seiden; Motto et al. 1974; Shneidman 1976). 4 The formation of the American Association of Suicidology followed the first national conference on suicidology held in 1968 (Davis 1983). By 1972, efforts by some colleges and universities were expanding by offering crisis intervention courses including suicide prevention techniques (Hoffer 1973; Whitaker and Slimak 1990). Resident assistants were being trained in those crisis intervention techniques and telephone hot lines usually staffed by volunteer students were being established to deal with suicide calls (Hoffer; Sivert 1973; Knott 1973; Sims and Bell 1973). But in 1971, only 66 American colleges and universities 5 offered therapy by professional psychologists and psychiatrists in campus clinics (Grollman 1971). the broadcast was remembered by American college and university staff as divergent as a media librarian in Texas to the director of a counseling center at a national university in the Midwest. Bernard and Bernard (1985) mention the broadcast in their chapter of Coping with Death on Campus. Rickgarn (1994) used the broadcast as part of his discussion of myths surrounding student suicide. He stated, While there was a considerable amount of excellent information [in the broadcast] the main impression was that one school was the good guys and the other school was the bad guys it created a fear in the mind of administrators who could see their reputations being placed on the line should a similar production be made about their school (92). After the Broadcast (1980s to Early 1990s) After the broadcast of College Can Be Killing, a flurry of articles was published relating to the issue of student suicide. The tone of many of the articles changed. Although the questions of rates and predictors of student suicide were still discussed (Heinrichs 1980; Kraft 1980; Schwartz 1980; Wright, Snodgrass and Emmons 1984), other articles appeared which dealt with specific responses a campus should do in the event of a student s death by suicide or other means. A comprehensive plan for campuses to use in the event of a suicide was presented (Hipple, Cimbolic and Peterson 1980). Some step-by-step guidelines appeared to The one-hour broadcast described events surrounding the suicide of a Northwestern University student and included scenes of the discovery of her body in her dormitory s parking lot and at her graveside services. The broadcast compared the knowledge and reactions of Northwestern officials to those of staff from the University of Wisconsin Madison. There were interviews with students who had thought of or had attempted suicide who talked about the loneliness and isolation they felt on their campuses. The Broadcast of College Can Be Killing (1978) In 1978, the Public Broadcasting System (PBS) presented a television documentary called College Can Be Killing (Hirsh 1978). The one-hour broadcast described events surrounding the suicide of a Northwestern University student and included scenes of the discovery of her body in her dormitory s parking lot and at her graveside services. The broadcast compared the knowledge and reactions of Northwestern officials to those of staff from the University of Wisconsin Madison. There were interviews with students who had thought of or had attempted suicide who talked about the loneliness and isolation they felt on their campuses. Prevention efforts on both campuses were examined. Twenty-five years later, be used by college student affairs staff in response to any type of sudden death of a student (Crafts 1985; Halberg 1986). One was written specifically for responding to suicides (Butler and Statz 1986). These were similar to Donohue s (1977) work, which was one of the first to address, such basics as family notification, news releases and planning memorials although Donohue did not mention suicide as a form of student death. Several articles dealing with student death were published in the NASPA Journal (Jacobs and Towns 1984; Wright et al. 1984; Butler and Statz 1986; Charles and Eddy 1987). For the first time, there appeared discussions about how colleges and universities winter 2014 JOURNAL OF COLLEGE ADMISSION 37

5 should respond to deaths on campus. Jacobs and Towns (1984) and Charles and Eddy (1987) advocated grief education training for student assistants in residence halls. A call was made for a comprehensive program designed to sensitize and prepare student personnel professionals, residential living staff, paraprofessionals, faculty, and the general student population to prevent suicide and to recognize and react to potentially suicidal students (Wright et al., 62). This was very different indeed from of the watchful waiting and hospitalization responses (Temby 1961) of the period before the 1970s. However, research published in 1980 and 1986 showed many American colleges and universities still were not establishing systems to deal with student suicide. Bernard and Bernard (1985) surveyed 87 accredited university and college counseling centers in the US between 1975 and 1978 about those schools responses to students threats or attempts of suicide. Many of the institutions indicated that they consider a wide spectrum of possible reactions to an instance of suicidal behavior, ranging from ignoring it completely to dismissing the student (110). Of the 87 responding institutions, 56 indicated they would take no official action or would make suggestions of some sort in response to suicide threats and 42 would do the same in response to suicide attempts (Bernard and Bernard). In the mid 1980s, only one university in a random sampling of Big Ten 7 and Big Eight Conference schools 8 provided evidence of policies or systematic procedures associated with the suicide of a student (Butler and Statz 1986). That school had a policy statement, specific death report forms and defined follow-up procedures. It also provided its residence hall staff with a brief list of the myths and telltale signs associated with suicidal behaviors, but provided no systematic training to either residence hall or student affairs staff (17). By the late 1980s, at many American schools, a student who attempted suicide on campus would be removed from campus pending a psychological evaluation by a qualified counselor or doctor. This response was justified by a perceived need to protect and respect the mental well-being of roommates, friends and classmates of the suicidal student (Sherrill 1989). Concerns with legal issues and liability surfaced especially as they related to violations of client confidentiality and failure to adequately protect students (Yarris 1996). Postvention, a term created in the 1970s by Shneidman, was used to describe the help and intervention of others that is needed by all survivors of suicide (attempters, families of suicides, friends, associates, etc.) (Rickgarn 1994, 165). Models for campus postvention to take place after a suicide or other types of violent death on campus began appearing in the literature with increasingly detailed models appearing in the 1990s (Swenson and Ginsberg 1996). During the Later 1990s In January 1989, the US Public Health Service issued the Report of the Secretary s Task Force on Youth Suicide in response to the public demand for action to end these tragic events (high rates of youth suicide in the U.S.) (1989a, 3). This four-volume report of commissioned papers, summaries and commentary provided a wealth of information and recommendations for action to people concerned with the issue of youth suicide (US Public Health Service 1989a, 1989b, 1989c, 1989d). As part of the response to the 1989 report, the number of articles relating to student suicide greatly increased in the 1990s. Two searches of the ERIC database using the same data strings were conducted for this study (see Table 1). The first revealed that between 1966 and 1981 (15 years), 14 articles on student suicide were listed. Using the same search criteria for between 1992 and 2000 (eight years), 69 articles on student suicide were recovered. Increased numbers of specialized journals concerned with suicide started publication. These included Death Studies; Suicide and Life-Threatening Behavior; Crisis: The Journal of Crisis Intervention and Suicide Prevention; and Omega: an international journal for the study of dying, death, bereavement, suicide and other lethal behaviors. Table 1. ERIC Data Base Comparison Using deliminators 1966 to to 2000 Higher 73,576 82,819 Education 290, ,485 Combined (higher + education) 65,888 75,293 Student 93,848 79,393 Suicide 412 1,072 Combined (higher + education) and (student + suicide) Source: ERIC Data Base on TexSearch, conducted October 2000 Suicide and Life-Threatening Behavior became available online. The specialized journals also published special issues such as Omega s on elderly suicide (Volume 42, #1, ) and Right to Die versus Sacredness of Life (Volume 40, #1, ). The term suicidology was created by Shneidman (2001) and became part of the Oxford English Dictionary. The Comprehensive Textbook of Suicidology, all 650 pages of it, was published by three leaders in the field (Maris, Berman and Silverman 2000). Books were devoted specifically to the issue of college student suicide (Rickgarn 1994; Whitaker and Slimak 1990). 38 winter 2014 JOURNAL OF COLLEGE ADMISSION

6 Student suicide was given attention in textbooks for student affairs students and professionals (Komives, Woodard and Associates 1996; Rentz 1996). In a phone interview with the author on November 22, 2000, Morton M. Silverman, director of Student Counseling and Resource Service at the University of Chicago, stated a significant destigmatization of mental health problems by American society in the late 20th Century led to improvement in awareness and acceptance of the issue of suicide on campus. Therefore, due to increased acceptance of all types of mental health issues, more people were concerned and aware of the potential of a student committing suicide. At the University of Chicago, the counseling center was not the only place on campus that provided intervention and support. Coaches, trainers, writing tutors, campus ministers, housing staff, and others spotted suicidal people and interventions could happen all over the campus. This same redundancy of efforts was noted by John Hipple, counselor and associate professor of counseling psychology at the University of North Texas, in an interview with the author on October 10, And Harvard University (MA) suicide research (Rogers 2001). Even more disturbing was that the journal for the American College Health Association (ACHA) published only one article about the issue of suicide between 1997 and May 2001 (Barrios et al. 2000). The ACHA had been the leader in research on college student suicide, funding some of the first research (Braaten and Darling 1962) and publishing many articles relating to the subject. University and college administrations are now somewhat more aware of the prevalence mental illness in their undergraduates and graduate students and increasingly shaken into action by the too-frequent suicides of young people. But they are not nearly aware or active enough (Jamison 1999, 262). Rickgarn (1994) also expressed his concern that the academic community, administrators, faculty, staff, and students, were denying that suicide continued to be a problem. And it was still a problem. Although the number of high school youth who seriously considered suicide at least once in the previous 12 months had dropped between 1991 and 2001 (from 29 percent to 19 percent) and who planned to attempt suicide (from 18.6 Morton M. Silverman, director of Student Counseling and Resource Service at the University of Chicago, stated a significant destigmatization of mental health problems by American society in the late 20th Century led to improvement in awareness and acceptance of the issue of suicide on campus. Therefore, due to increased acceptance of all types of mental health issues, more people were concerned and aware of the potential of a student committing suicide. planned to create an intentionally redundant support network so suicidal students would not escape detection and could receive help (Gose 2000). Still there was a disturbing trend in the paucity of articles published in the journals for student affairs practitioners in the late 1990s. From 1997 through April 2001, there were no articles relating to suicide in either the NASPA Journal or the Journal of College Student Development, the journals for the two largest generalist associations for student affairs professionals in the US during the late 20th Century. The American Counseling Association s Journal for Counseling and Development published four articles relating to suicide in 2000 and the first half of Two were concerned with schizophrenia and suicide (Schwartz, R. C. 2000; Schwartz and Cohen 2001). One dealt with rational suicide, a term appearing in the literature in the 1980s and encompassing physician-assisted suicides (Rogers, Gueulette et al. 2001). The fourth discussed theoretical grounding and percent to 14.8 percent), the number who attempted suicide stayed the same (CDC 2002). By the late 1990s, some colleges and universities had developed detailed plans and procedures to use in the event of student suicide (Mitchell, Elmore and Fygetakis 1996). An example was at the University of North Texas in Denton, Texas. All resident staff from the desk clerks to the central housing administration was given spiral flip booklets specifying what the person in that job was to do in the event of a major emergency in the halls (University of North Texas Housing Department 2000). The emergency response procedures were based on a four-page document created by housing staff, campus police, health center personnel, the university s legal counsel and the vice president of student affairs office. Of the 12 events listed in the flipbook, a full page layout was devoted to what to do if a suicide attempt takes place while a person was on duty. The title of the page was Suicide Threats and Attempts. winter 2014 JOURNAL OF COLLEGE ADMISSION 39

7 Into the 21st Century As American society moved into the 21st Century, the problem of suicide among its youth did not go away. In 2010, suicide still was the third most common cause of death in the US for youth ages 15 to 24 following unintentional injuries (including motor vehicle crashes) and homicide, although the actual number of suicides decreased compared to those in 1980 (5239 in 1980 versus 4600 in 2010) (CDC 2012). 9 Some research claimed, The suicide rate for students at four-year colleges is the US is half the rate of matched groups in the general US population (Schwartz, A. J. 2006b, 356) at 6.5 suicides per 100,000 students (Schwartz, A. J. 2006b, 344). However, that still meant an estimated 1,100 college students would die by their own hand each year (The Jed Foundation/NMHA 2002). The responses of American colleges and universities continued to evolve. Part of the impetus to change was fueled by several high profile lawsuits involving American colleges and universities (Shin v. Massachusetts Institute of Technology MIT; Schieszler v. Ferrum College; and Jain v. the State of Iowa [the University of Iowa]) where families of students who committed suicide sued their schools. Another high profile event was the 1998 suicide of a chemistry graduate student at Harvard University (MA) which received far-reaching press coverage in the US and internationally. It marked the fifth suicide within the [Harvard] University community during the academic year and the second suicide within the Graduate School of Arts and Sciences It is also the second death in the chemistry department in two years (Harvard Crimson 1998). The student s graduate adviser was Nobel laureate Elias J. Corey and the student was widely known and well liked, and was by all accounts the golden boy of the Corey (research) group, perhaps the finest synthetic organic chemistry laboratory anywhere in the world (Hall 1998). In one of the suicide notes the student left, he claimed his death was in part because ''professors here have too much power over the lives of their grad students and the university needed to ''provide protection for graduate students from abusive research advisers (Hall 1998). This suicide in August 1998 was followed by Shin s suicide at MIT in April of 2000 and her parents January 2002 wrongful-death lawsuit against MIT and several administrators and employees. Both of these events at major universities in the US received wide spread news coverage and put college students suicides into the forefront of American thought. 10 From 1999, a series of mass shootings plagued the US. These occurred at colleges and universities (Virginia Tech, Northern Illinois University, Oikoas University (CA), Santa Monica College (CA), University of Alabama, University of Arizona, San Jose State University (CA), Louisiana Technical College), schools (Sandy Hook Elementary School, Columbine High School, Red Lake High School, West Nickel Mines Amish Elementary School) and public places or places where people gather (Wedgwood Baptist Church, Oak Creek Sikh Temple, Aurora, CO movie theater, Westroads Mall in Nebraska, Tucson, AZ supermarket parking lot, Washington DC Navy Yard). Many of these events ended with the killers either allowing themselves to be killed by police (suicide by cop or copicide: AAS 2013) or committing suicide with the gun they used to murder their victims. These events heightened the awareness that all individuals on campus needed to know the signs of mental distress and what to do when people exhibited these signs. A number of academic journal articles and monographs appeared addressing legal issues, college and university liability and college student suicides (Lake and Tribbenesee 2002; Franke 2004; Moran Pavela 2006a; Westefeld et al. 2006; Gray 2007; The Jed Foundation 2008; Baker, T. 2009; Kalchthaler 2010). Katchthaler s extensive review of current case law attempted to determine when a college could be held liable for its failure to prevent a student suicide (900). She addressed two questions: 1) What role should colleges and universities play in addressing student suicide? and 2) What liability will and should colleges incur in this role? ( ). The review included lengthy discussions of the Shin, Jain and Schieszler cases and their results. Change did begin. In 2009 the NASPA Journal published the results of The Status of Crisis Management in NASPA Member Institutions. In the 2001 study, the five types of crises institutions reported most frequently included: fire (91.8 percent), student death (89.0 percent), sexual assault (87.7 percent), suicide (85.6 percent), and campus disturbance or demonstration (84.2 percent). The five types of crises institutions reported most frequently in the 2007 study included: student death (90.3 percent), fire (90.0 percent), infectious disease (87.0 percent), suicide (86.4 percent), and evacuation of buildings (86.4 percent) (emphasis, author s) (Catullo, Walker and Floyd 2009, 309). Although the percentage of reporting suicide changed little, of the 158 reporting universities, 57 had contingency plans to deal with student suicide in 2001 and nine more added such plans by The respondents were made aware that a contingency plan indicated there was a separate written procedure or checklist that addressed the specifics of that crisis (Catullo, Walker and Floyd 2009, 310). And between 2000 and 2013, the NASPA Journal published 11 articles with suicide in the title. 40 winter 2014 JOURNAL OF COLLEGE ADMISSION

8 During the same time period the American College Health Association s journal yielded 116 articles when suicide was entered in the search field. Twenty-four had suicide in the title. In the sixth issue published in 2006, there were four articles relating to student suicide one of which discussed whether or not institutions should withdraw students who threaten or attempt suicide (Pavela 2006b) and two were overviews of the study of college student suicide in the US since 1920 (Schwartz, A.J. 2006a, 2006b). In 2012, the journal published a special section on suicide prevention, which included six articles ranging from an overview of the state of suicide prevention research to articles on race/ethnicity and sexual minority differences relating to depression and suicidal behavior. generated numerous studies (CCMH 2013a) about the mental health of US college students. Plans of action for colleges and universities were discussed in several reports (The Jed Foundation/NMHA 2002; Francis 2003; Westefeld et al. 2006; Schwartz, A. J. 2006b; Kalchthaler 2010). In 2002, The Jed Foundation 11 partnered with the National Mental Health Association (since changed to Mental Health America) to conduct a roundtable with leading experts to address the issue of suicide on American college campuses. The report of this group was directed toward campus administrators and its information was designed to help you assess the current status and need During the same time period the American College Health Association s journal yielded 116 articles when suicide was entered in the search field. Twenty-four had suicide in the title. In the sixth issue published in 2006, there were four articles relating to student suicide one of which discussed whether or not institutions should withdraw students who threaten or attempt suicide (Pavela 2006b) and two were overviews of the study of college student suicide in the US since 1920 (Schwartz, A.J. 2006a, 2006b). Research centers were established to study the issue. The Center for Collegiate Mental Health (CCMH), established in 2004 at Penn State University, focused on providing accurate and up-to-date information about the mental health of today's college students in order to serve the needs of mental health providers, administrators, researchers, and the public (CCMH 2013b). By 2013, 239 counseling centers at US colleges and universities participated in its research. The counseling centers used a standardized set of questions typically asked students who were seeking services (CCMH 2012). The set included 22 questions and also demographic information about the student. Question 7 was Have you seriously considered attempting suicide? and Question 9 was Have you made a suicide attempt? Other questions were: Have you purposely injured yourself without suicidal intent (e.g., cutting, hitting, burning, hair pulling, etc.)? Have you considered causing serious physical injury to another person? Have you intentionally caused serious physical injury to another person? The counseling centers collected the responses from their student clients and shared this information with the CCMH. The center of your institutions, as you ask yourself and your colleagues, What safeguards do we have in place against suicide? (The Jed Foundation/NMHA 2002, 2). The report discussed 12 essential services a campus needed to provide to address suicidal behaviors on campus. These were divided into administrative policies, riskidentification programs, on-campus support services, and community-based support services. Suggested were screening programs, broad-based education programs to all segments of a college campus including parents and families, stress reduction programs, student support networks, onsite counseling and medical services, off-campus referrals, emergency services, postvention programs, and medical leave polices. The report was distributed to 3,000 colleges and universities in the US (Mental Health America 2013) and was cited frequently in the literature since its publication. The list of the 12 essential services were included in a survey of college and university counseling center directors in 2007 and 2012 asking them if their campus provided these services (Rando et al. 2007; Mistler et al. 2012). Francis (2003) approached the topic from the perspective of a college counselor and counseling center administrator. He proposed that an optional institutional policy for responding to suicidal students include assessments of suicidal ideations and winter 2014 JOURNAL OF COLLEGE ADMISSION 41

9 the training of staff to make those assessments, methods for responding to threats and attempts that were reported to faculty or staff, procedures for involuntary commitments to a hospital or inpatient mental health center, policies regarding who should be notified when an attempt or threat was made and associated steps to provide accountability (emphasis, author s). Concerns about confidentiality, parental notification and mandatory treatment were raised. Francis also discussed non-traditional students and issues relating to contacting those people s families. Westefeld et al. (2006) believed it was critical for schools to screen for suicidal risk, conduct prevention workshops, and have counseling services available for those students in need. These services need to be well-publicized and readily accessible (942). The researchers also discussed the need for postvention as a part of a suicide prevention program and a school s response to a student s death. Kalchthalaer (2010) proposed a three-part plan to balance the competing interests of student privacy and student safety. The plan had the goal of protecting students and providing colleges the much-needed clarity of what is required of them to avoid liability (918). She suggested the courts establish a clear standard as to what a college s duty was to suicidal students. Then each college needed to develop a plan to action known to all about how to deal with a student with mental health issues. Finally, schools should use the emergency exception in FERPA to notify parents in the event a student is at risk of hurting either himself or others (918). In 2006, The Jed Foundation published a Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student. This document presented a model for protocols and a list of issues that needed to be addressed when a college or university developed or revised policies relating to at-risk students. The framework was presented in three different sections: Developing a safety protocol, developing an emergency contact notification protocol and developing a leave of absence and re-entry protocol. An appendix dealt with legal issues. The authors promoted a suicide prevention model that moved in a continuous flow from prevention, intervention and postvention. In response to the mass killings at Virginia Tech in 2007 and North Illinois in 2008, a number of schools created campus teams to deal with students whose behavior caused concern. Actually mandated by law in Virginia and Illinois, public campuses in those states were required to convene formal teams to assess and respond to potentially violent threats (HEMHA 2008). The idea was to identify troubling students including those with suicide ideation and/or who had attempted suicide, and engage them sooner rather than later, so that they can receive needed referrals or other appropriate assistance and treatment (1). Although campus response teams had existed before, the legal requirement to have such teams was new. These teams were called different things such as Ohio State University s Consultation and Assessment Team or the University of North Texas CARE team. At the University of Illinois at Urbana-Champaign, the Behavioral Intervention Team met weekly to evaluate the behavior of students who posed a potential risk to themselves and others (UIUC 2013). The Higher Education Mental Health Alliance (HEMHA) was formed in 2008 under the leadership of the American College Health Association (ACHA) and was a partnership of organizations concerned with the mental health of college students. It developed a guide for the formation of campus teams (HEMHA 2008). Included were flow charts for the protocols for the teams for Ohio State (19) and the University of North Texas (16). Callahan and Fox (2008) presented a practical discussion of the steps a school needed to complete in the event of a student death. Given were lists of activities to be considered broken down by departments and timelines. FERPA considerations were included. In addition, there was a list of formulated protocols and procedures from 12 colleges and universities that were available for review online. Student death protocols are plentiful The important thing to keep in mind is that each institution needs to consider its own culture and its own organization and to develop a protocol that is appropriate for its community (93). Two issues reappearing frequently in the literature were parent notification and mandatory counseling and/or withdrawal from the school. Parent notification (Lake and Tribbensee 2002; Francis 2003; Franke 2004; AUCCCD 2007; Gray 2007; Rando et al. 2007; Baker, T. 2009; Kalchthaler 2010; Mistler et al. 2012) was discussed as the balance between the student s privacy interests and a school s desire to contact a parent or family member of a student exhibiting disturbed or suicidal behavior. Most of the wrongful death lawsuits filed against colleges and universities had a component dealing with parent notification. The issue further was complicated by FERPA (Family Educational Rights and Privacy Act), a federal law that protected the privacy of student educational records (US Department of Education 2013). When a student turned 18 years old or entered a postsecondary institution at any age, all rights afforded to parents under FERPA transferred to the student. However: In an emergency, FERPA permits school officials to disclose without student consent education records, including personally identifiable information from those records, to protect the health or safety of students or other individuals. At such times, records 42 winter 2014 JOURNAL OF COLLEGE ADMISSION

10 and information may be released to appropriate parties, such as law enforcement officials, public health officials and trained medical personnel This exception to FERPA's general consent rule is limited to the period of the emergency and generally does not allow for a blanket release of personally identifiable information from a student's education records. In addition, the Department interprets FERPA to permit institutions to disclose information from education records to parents if a health or safety emergency involves their son or daughter (US Department of Education 2007). this assessment is to provide the student with resources to adhere to this standard in the future and to monitor the student s willingness and ability to adhere to this standard (UIUC 2013). Means reduction was another issue to emerge during the second decade of the 21st century. An important element in a comprehensive suicide prevention approach, means reduction referred to suicide prevention efforts that focused on reducing a person s access to lethal means of killing one s self (Harvard School of Public Health 2013). Use of firearms (Schwartz, A.J. 2004b) and In an emergency, FERPA permits school officials to disclose without student consent education records, including personally identifiable information from those records, to protect the health or safety of students or other individuals. At such times, records and information may be released to appropriate parties, such as law enforcement officials, public health officials and trained medical personnel This exception to FERPA's general consent rule is limited to the period of the emergency and generally does not allow for a blanket release of personally identifiable information from a student's education records. In addition, the Department interprets FERPA to permit institutions to disclose information from education records to parents if a health or safety emergency involves their son or daughter (US Department of Education 2007). Mandatory or involuntary dismissal from school or required counseling for a student who exhibited troubling behavior or who had threatened or attempted suicide was discussed in the literature (Moran 2003; Franke 2004; Pavela 2006b; Westefeld et al. 2006; AUCCCD 2007; Gray 2007; Keller 2007; AUCCCD 2011). This was an issue with no clear-cut consensus. A frequently mentioned plan for mandated counseling/assessment sessions was the Illinois or Joffe plan (Pavela 2006a, 2006b; Gray 2007; Kalchthaler 2010). The plan or its variations were built around requiring counseling sessions for any student involved with suicide under threat of dismissal from the school. The plan was created in 1984 when Dr. Paul Joffe (2008) founded the Suicide Prevention Team at the University of Illinois in Urbana-Champaign (UIUC). The following was posted on the university s counseling center s website: In the event that the university is presented with a credible report that a student has threatened or attempted suicide, engaged in efforts to prepare to commit suicide or expressed a preoccupation with suicide, that student will be required to attend four sessions of professional assessment (emphasis, author s). The purpose of jumping off high places were considered highly lethal means of suicide because once the attempt is begun (the person jumps or pulls the trigger) it cannot be stopped (Harvard). Cornell University in Ithaca, NY, is built in an area of deep and beautiful gorges crossed by seven high gorge bridges that run throughout the campus. Between 1990 and 2010, 23 people committed suicide by jumping from the bridges or their abutments on or near the Cornell campus. Three other individuals survived their attempts. Roughly half of the jumpers were Cornell students, three of whom took their lives in one month in early 2010, two within one day of each other (Marchell 2011). One student jumped to his death in February His family filed a lawsuit against Cornell, alleging that the institution didn't do enough to restrict access to a particular means of suicide Cornell was negligent for not having installed barriers on the campus bridge For not taking steps to block bridge suicides both Cornell and the city were negligent, careless, and reckless in failing to provide for safety and protection for vulnerable or impulsive individuals. University and city officials knew that area bridges were a recurring site of suicides winter 2014 JOURNAL OF COLLEGE ADMISSION 43

11 and therefore had an obligation to restrict access to them (Stratford 2012). In March 2010, Cornell did put fences and guards around their bridges and by mid-2013, had installed safety nets of low-visibility tensile steel mesh underneath six of the bridges and planned to install a steel mesh sock around the seventh (Cornell University Facility Services 2013; Kelly 2013). Another school that dealt with means reduction was New York University (NYU) whose Bobst Library with its 12 story open atrium had been the scene of three student deaths by jumping. Two took place in Fall semester 2003 and were two of six suicides by jumping completed by NYU students during By 2005, university officials installed eight-foot-tall plexiglass panels around the perimeter of the atrium and restricted access to the balcony areas. However, another student jumped in 2009 (Schmidt 2009). In 2012, 20 foot tall gold aluminum screens were added to completely enclose the atrium s jump points (Huffington Post 2012). In 2004, the Garrett Lee Smith 12 Memorial Act was signed into law (Goldston et al. 2010). It was the first Federal legislation to provide funding for youth suicide prevention programs. The act authorized $82 million to be used by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the US Department of Health and Human Services, to fund these programs over three years. During the first three years, approximately $2.3 million per year was made available to fund up to 31 awards amounting to $75,000 each. By 2013, 82 institutions of higher education had received grants for suicide prevention programs (SPDC 2013). College grants have been awarded to fund six types of activities for suicide prevention and improving access and linkages to services for mental health and substance abuse problems: 1) educational seminars 2) crisis hot lines (or promotion of the National Suicide Prevention Lifeline, TALK) 3) preparation of informational materials 4) preparation of educational materials for families of students to increase awareness of potential mental and behavioral health issues 5) training programs (e.g., gatekeeper training) for students and campus staff to enhance their ability to respond effectively to college students with emotional or behavioral difficulties including substance abuse and suicidal behavior that might lead to school failure and 6) creation of an infrastructure for linking institutions of higher learning without adequate mental health resources to health care providers that can provide these services (Goldston et al. 2010, 3). In Spring 2013, the Jossey-Bass higher education quarterly series published a book that described successful strategies implemented by grantee campuses (to) serve as models to address student suicide and prevention on other campuses (Taub and Robertson 2013). Other colleges and universities expanded their suicide prevention efforts. By 2012, 302 college and university counseling center directors (out of 400 who responded to an annual survey) reported their centers were involved in some form of suicide prevention outreach services (Mistler et al. 2012, 180). And 386 reported using some form of suicide prevention protocol which ranged from QPR - Question, Persuade, and Refer from the QPR Institute (32 percent), a locally developed model (23 percent) or more than 20 other plans (39). It was likely that more colleges and universities had prevention programs because the survey s response rate was 47 percent. Internet Presence Arguably, one of the biggest changes in American life in the 21st Century was the development of computer and wireless technology that gave people to easy access to information available on the Internet. Combined with the development of powerful Internet search engines (software systems designed to search for information placed on the Internet) and affordable and accessible devices, finding information became extremely straightforward. This availability of information influenced the ways colleges and universities in the US dealt with suicide and suicide prevention on their campuses. Articles relating to using the Internet in suicide prevention efforts began to appear in the literature (Krysinska and De Leon 2007; Haas et al. 2008; Manning and VanDeusen 2011). Online screening instruments, many of which were tied to a counseling center at the students school, began to appear and were put into use (Haas et al. 2008; Screening for Mental Health, Inc. 2013b with Cornell 2013a; UMBC 2013c; UTA 2013d). The Jed Foundation also developed an Internet presence. Besides its own website (www.jedfoundation.org), it partnered with MTV and its MTV U site to develop a program called Half of Us (www. halfofus.com) dealing with emotional health. The program was available to MTV U watchers and used videos and interactive content to get its message to college students. By 2013, The Jed Foundation website was extensive with sections for college professionals, as well as parents, students and supporters. It also had a website called U Lifeline (www.ulifeline.org) specifically for college students who were experiencing severe mental health problems themselves or whose friends were in difficulty. On U lifeline, when the student used the Self Evaluator tab to take an online assessment, the site first asked the student s school. Once the school was selected, a start page appeared with half of the page devoted to specific information about that school s counseling services and how to make an appointment. 44 winter 2014 JOURNAL OF COLLEGE ADMISSION

12 Other organizations developed Internet presences aimed to college students or young adults. The Trevor Project (www.thetrevorproject.org) focused on the issues of LGBTQ youth (lesbian-gaybisexual-transgendered-questioning) (Stanley 2013). Active Minds (www.activeminds.org) was concerned with mental health advocacy by college students for college students. The National Suicide Prevention Lifeline (www.suicidepreventionlifeline.org) created a program called You Matter that could be accessed from its main page using a button labeled more help for young adults. The site had interactive links to blog postings and interactive content including one titled 100 ways to get through the next five minutes (www.youmatter.suicidepreventionlifeline.org). Many of these sites were used by US colleges and universities as online resources for their own student suicide prevention efforts. By the start of 2014, smart phone mobile technology was common on US campuses and the preferred method of communication for many students. Just in Case in College, (ereadia 2013), a mobile phone application, became available in Made to be customized for an individual campus and to use that campus and community s intervention services, the application purpose was to connect students with emergency responders if the student or a friend was potentially suicidal. In March of 2013, NASPA partnered with the counseling centers with psychological and social developmental programming, written policies and procedures for dealing with student death and ongoing research about suicidal students and the effects of the suicide act on all members of the campus community. The rapidly increasing suicide rates beginning in the 1950s and the shock of the 1978 PBS broadcast, College Can Be Killing, caused campus administrators to increase their consideration and concern about the issue. The liability lawsuits of the early 2000s and the increase in mass shootings on college campuses and in other public places only caused more focus on the issues surrounding suicide on college campuses. Attention was given to how colleges or universities respond to death on their campuses. Something as simple as keeping track of the number of suicides which happened on a campus became commonplace. There was much more discussion about how to deal with suicide threats and attempts. Suicide prevention programs combined with mental/emotional health initiatives. Campus teams began to be a standard element of colleges and universities efforts to deal with troubling students. The Internet made information much more accessible. Survivors of a completed suicide were acknowledged and postvention activities were developed and implemented on campuses. Research went beyond a few studies on the rates and reasons students kill themselves The responses of colleges and universities in the US to the event of a student s suicide changed during the 20th Century. From denial of the extent of the problem and the watchful waiting and hospitalization practices of the 1960s and earlier (Temby 1961), the profession moved to suicide prevention programs, counseling centers with psychological and social developmental programming, written policies and procedures for dealing with student death and ongoing research about suicidal students and the effects of the suicide act on all members of the campus community. developer to establish a group of early adopter schools (ereadia 2013). Introduced as a free app to students at the University of Miami in Ohio in August 2013, the app was viewed by more than 1,000 people within one month (Peale 2013). By December 2013, schools across the US were using the application (ereadia 2013). Conclusion The responses of colleges and universities in the US to the event of a student s suicide changed during the 20th Century. From denial of the extent of the problem and the watchful waiting and hospitalization practices of the 1960s and earlier (Temby 1961), the profession moved to suicide prevention programs, to the development of instruments to measure suicidal ideation 13 among students and studies that looked at student mental health across the US. We weren t prepared and there s no way we ever want to go through that again. It may never happen again, we hope it doesn t But, we no longer live in delusion. We now are ready to deal with the reality, (Dean of Students quoted in Rickgarn 1994, 173). During the preparation of this study, a 16-year-old who saw the pile of books and articles that included the terms suicide and adolescent or student suicide in the titles, exclaimed, Wow, how morbid! Why do you want to have anything to do with that? When winter 2014 JOURNAL OF COLLEGE ADMISSION 45

13 the author was making an appointment with the lead counselor at a large regional research university who is that campus authority on suicide and its prevention, the counselor said, Let s talk about gloom, doom, death, and disaster. The teenager s statement was a slightly fascinated denial of the reality of suicide as an element of student life. The counselor s statement was an acceptance that students trying to kill themselves were aspects of campus life with which colleges and universities must deal. Talking about that reality, implementing suicide intervention and prevention strategies, deciding what the appropriate reactions to suicide attempts will be, and helping the survivors of a suicide, all needed to be part of the fabric of campus life. As the 20th Century moved into the 21st Century, student affairs staff, both as individuals and as a profession, recognized the reality of student suicide and started combating that slightly fascinated denial of suicide as a problem on American college and university campuses. Endnotes 1 The terms student services, student personnel and student affairs all have described the tasks of administrators and staff who work at American colleges and universities to provide programs and services for students outside of the classroom. Student affairs staff serve a variety of functions and roles, including the vice president and dean for student life, as well as professionals working within housing and residence life, student unions, student activities, counseling, career development, orientation, enrollment management, racial and ethnic minority support services, and retention and assessment (NASPA 2013). 2 Much excellent work was done on these issues. The Journal of College Student Psychotherapy devoted half of its 1990 publications to student suicide. College Student Suicide, Volume 4, numbers 3 and 4, were a solid grounding in this area and was available in book form (Whitaker and Slimak 1990). 3 There were many sources for that information including internet sites for the National Institute of Mental Heath (NIMH) and the American Association of Suicidology. 4 One of the first centers for suicide prevention was founded in Los Angeles in 1958 (Grollman 1971). 5 By 2007 there were 4314 two and four-year colleges and universities in the US (Infoplease 2013). 6 Northwestern University (NU) is a private research university with campuses at Evanston and Chicago, Illinois, United States. 7 The Big Ten is a US college athletic association located primarily in the American Midwest. Schools included are Indiana University Bloomington, Northwestern University (located in Chicago, Illinois), Michigan State University, Ohio State University, Pennsylvania State University (Penn State), Purdue University (located in West Lafayette, Indiana), University of Illinois at Urbana Champaign, University of Iowa, University of Michigan, University of Minnesota, and University of Wisconsin Madison. In the later part of the 20th century, more than 350,000 students attended these schools (Big Ten Conference 2013). 8 The Big Eight Conference, a former US college athletic association, was formed in 1907 and dissolved in The member schools at the time of dissolution were located in the central part of the US and included Iowa State University, Kansas State University, Oklahoma State University, University of Colorado, University of Kansas, University of Missouri, University of Nebraska, and University of Oklahoma (BigEightSports.com 2013). 9 Among all persons in the US, suicide rated as the 10th most common cause of death in both 1980 and The number of suicides reported as cause of death based on death certificates increased from 26,869 in 1980 to 38,364 in 2010 (CDC 2012). 10 Time Magazine When the Young Take Their Lives: Suicide among college students is up. How do you spot a kid at risk and what should you do? (Gupta 2002) and On Campus: University Blues A Crisis (Kim, 2003); New York Times Who Was Responsible for Elizabeth Shin? (Sontag 2002) and In College and in Despair, With Parents in the Dark (Tavernise, 2003); Washington Post College Privacy Policies Create Different Parent-Child Conflict ; Suicide Attempts, Drinking Often Go Unreported at Home (Crary 2002). 11 The Jed Foundation was established in 2000 by Donna and Phil Satow, whose son, Jed, a University of Arizona sophomore, committed suicide in The foundation s mission was to promote emotional health and prevent suicide among college and university students (Jed Foundation 2013). 12 Garrett Lee Smith was the 21-year-old son of Oregon Senator Gordon Smith. Garrett committed suicide in 2003 while a student at Utah Valley State College (SAMHSA 2007; Colburn 2004). 13 Suicidal ideation is thoughts about how to kill oneself, which can range from a detailed plan to a fleeting consideration and does not include the final act of killing oneself. The majority of people who experience suicidal ideation do not carry it through. Some may, however, make suicide attempts. Some suicidal ideations can be deliberately planned to fail or be discovered, while others might be carefully planned to succeed (Medical News Today 2010). REFERENCES American Association of Suicidology (AAS) Suicide by Cop Fact Sheet. get_file?folderid=262&name=dlfe-833.pdf Arenson, Karen W Worried Colleges Step Up Efforts Over Suicide. New York Times, December 3. fullpage.html?res=9e0de6dd1631f930a3575 1C1A9629C8B63 Association for University and College Counseling Center Directors (AUCCCD) Association for University and College Counseling Center Directors (AUCCCD) Statement on Parental Notification, Mandatory Counseling and Counseling Center Director Status. Statement_ pdf Association for University and College Counseling Center Directors (AUCCCD) AUCCCD statement on Tucson Tragedy. statement_on_tucson_shooting_tragedy.pdf Baker, H. S A Nurse s Guide to the Acute Management of Suicidal Patients in the Student Health Center. Journal of the American College Health Association 26: Baker, Thomas R "Notifying Parents Following a College Student Suicide Attempt: A Review of Case Law and FERPA and Recommendations for Practice." NASPA Journal (Online) 46 (4): Barrios, L. C., S. A. Everett, T. R. Simon, and N.D. Brener Suicide Ideation among US College Students: Associations with Other Injury Risk Behaviors. Journal of American College Health Association 48 (5): Bernard, M. L., and J. L. Bernard Suicide on Campus: Response to the Problem. In Coping with Death on Campus, edited by E. S. Zinner, Vol. 31, San Francisco: Jossey-Bass Braaten, L. J., and C.D. Darling Suicidal Tendencies among College Students. Psychiatric Quarterly 36: BigEightSports.com Big 8 Conference: A Big Eight Conference Athletic History and Records Website. Peggy Brandt Brown had a 25-year career working with at-risk youth in higher education, the juvenile courts and human services agencies. In 2000, she decided to get her PhD in higher education from the University of North Texas, graduating in She is on the education faculty at North Lake College, Irving, Texas. Big Ten Conference About the Conference. school-bio/big10-school-bio.html Bruyn, H.B., and R.H. Seiden Student Suicide: Fact or Fancy? Journal of the American College Health Association 14: Butler, R.R., and M.A. Statz Preparation for When Prevention Doesn't Work: Responding to a Suicide. NASPA Journal 23 (3): Callahan, Cheryl M. and Erin K. Fox "Student death protocols: A practitioner's perspective." New Directions for Student Service (121): Catullo, Linda A., David A. Walker, and Deborah L. Floyd "The Status of Crisis Management at NASPA Member Institutions." NASPA Journal (Online) 46 (2): Cavan, R. S Suicide, First Edition. New York: Russell and Russell. Center for Collegiate Mental Health (CCMH) Standardized Data Set. Publication No. STA MPC Center for Collegiate Mental Health (CCMH). 2013b. Bringing Science and Practice Together. Center for Collegiate Mental Health (CCMH). 2013a. Annual Reports and Publications. Charles, K.E., and J.M. Eddy In-service training on dying and death for residence hall staff. NASPA Journal 25 (2): Colburn, Don Fraturnity (sic) of Sorrow. html Cornell University Facility Services Long Term Means Restriction for Bridges. Crafts, R., ed Student Affairs Response to Student Death, Vol. 31. San Francisco: Jossey-Bass. Crary, D College Privacy Policies Create Different Parent-Child Conflict; Suicide Attempts, Drinking Often Go Unreported at Home. The Washington Post, A(15): Feb winter 2014 JOURNAL OF COLLEGE ADMISSION

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