Title: Legal and Ethical Challenges in Counseling Suicidal Students.

Authors: Capuzzi, David

Source: Professional School Counseling; Oct2002, Vol. 6 Issue 1, p36,
10p
Document Type: Article
Subject Terms: *SUICIDAL behavior

*STUDENTS

*EDUCATIONAL counseling
Abstract: Presents a study that examined the legal and ethical
challenges in counseling suicidal students. Background of the ethnic and
gender differences related to suicidal behavior; Characteristics of
suicidal students; Details of practices for implementing prevention and
crisis management programs.
Full Text Word Count: 7208
ISSN: 1096-2409
Accession Number: 9395324

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Legal and Ethical Challenges in Counseling Suicidal Students

Suicide rates for adolescents have risen more than 300% since the 1950s,
yet the rates for the population in general have remained relatively
stable (King, 2001). In 1997, the suicide rate among 15- to 24-year-olds
was 11.4 per 100,000 (King, 1997). Almost 86% of all suicides by youths
under the age of 20 occur in 15- to 19-year-olds (National Center for
Health Statistics, 1996) and estimates of completed youth suicides range
from 7,000 to 9,000 a year. Even more alarming is the fact that, for
every youth suicide, there are between 100 to 200 youth suicide attempts
in this country (National Center for Health Statistics, 1992). Since a
teacher in a typical U.S. high school classroom can expect to have at
least one young man and two young women who attempted suicide in the
last year (King, 2000), many states are requiring that schools include
guidelines for suicide prevention, crisis management, and postvention in
their written tragedy-response plans. In addition, a number of states
require that all school faculty, administration, and staff participate
in workshops that address the parameters of youth suicide and provide
school personnel with information about risk factors and signs and
symptoms as well as direction for the protocol to be followed when youth
are identified as being at risk of self-harm.

Typically, school counselors are an integral part of school-based

suicide prevention, crisis management, and postvention efforts, and the
increased involvement with this segment of a school's population
presents a number of legal and ethical challenges to counselors as well
as other school faculty, administration, and staff. What are the ethical
obligations of school counselors and other school personnel once a youth
has been identified as potentially suicidal or has attempted or
completed suicide? What are the roles of faculty, staff, and
administrators and how do their roles differ from those of the school
counselor and crisis team member? How do schools work with parents and
guardians of minors to ensure that an appropriate constellation of
services is provided for a suicidal youth? Can the school or school
district be sued by families after an attempted or completed youth
suicide?

The purpose of this article is to answer these questions by addressing

"best practices" in the process of providing suicide prevention programs
in schools. Best practices are the aspirational standards an ethical and
well-informed school counselor should strive to attain in the process of
planning and implementing school-based prevention, crisis management,
and postvention efforts. They can be distinguished from minimally
acceptable practices which, though meeting most legal standards, may not
provide maximum protection to students and their families.

Since best practices, both legal and ethical, are always informed by
awareness of the guidelines that theory and research provide, a brief
overview of some of the literature available to school counselors on the
topics of ethnic and gender differences, methods, risk factors,
precipitants of acts of self-harm, myths, and the profile of a
potentially suicidal adolescent is provided. This is followed by a
description of best practices for creating and implementing prevention,
crisis management, and postvention programs. The article concludes by
highlighting the most important legal implications for school
counselors' roles.
Background

The information needed by counselors prior to planning and implementing

a suicide prevention, crisis management, and postvention program for a
school or school district is extensive. Such information is available to
counselors through a variety of resources. Ethnic and gender
differences, methods, risk factors, precipitants of attempts and
completions, myths, and the possible "profile" of a suicidal youth are
the topics that must be studied by school counselors interested in
reaching out to this at-risk population. These topics are briefly
reviewed for the purpose of providing school counselors with the
background needed to meet the legal and ethical challenges they will
encounter when counseling potentially suicidal students. Counselors may
use the articles and books cited in this section for further study.

Ethnic and Gender Differences

Some studies on youth suicide report that the suicide rate is higher
among adolescent males than among females (although adolescent women
attempt three to four times as often as adolescent men). Caucasian,
adolescent males complete suicide more often than any other ethnic group
(Canetto & Sakinofsky, 1998; Metha, Weber, & Webb, 1998; Popenhagen &
Qualley, 1998).

Although a number of explanations have been proposed to account for the

differences in rates among genders and races, no clear answers have been
found. Some models used to explain racial differences in suicide have
suggested that the extreme stress and discrimination that African
Americans in the United States confront helps to create protective
factors such as extended networks of social support, that lower the risk
and keep the suicide rates for African American adolescents lower than
those of Caucasian adolescents (Bush, 1976; Gibbs, 1988). Despite the
overall pattern suggested by the data, during the period between 1980
and 2000, the suicide rates for African American adolescent males showed
an increase of over 300% in the 10-14 age group and an increase of
approximately 200% in the 15-19 age group (Metha et al.; Speaker &
Petersen, 2000).

The literature on youth suicide continues to document the fact that

Native Americans also have high adolescent suicide rates in the United
States. There is considerable variability across tribes. The Navajos,
for example have suicide rates close to the national average of 11 to 13
per 100,000 of the population; some Apache groups have rates as high as
43 per 100,000 (Berlin, 1987). The high suicide rates in the Native
American population have been associated with factors such as alcoholism
and substance abuse, unemployment, availability of firearms, and child
abuse and neglect (Berman & Jobes, 1991). In general, less traditional
tribes have higher rates of suicide than do more traditional tribes
(Wyche, Obolensky, & Glood, 1990). Suicide rates for both Asian-American
and Hispanic-American adolescents continue to be lower than those for
African-American and Native-American youth even though the 1980-1994
time period bore witness to much higher rates than previously recorded
(Metha et al, 1998).

Methods

The use of firearms outranks all other methods of completed suicides;

firearms are used by both genders. Studies in the United States show
that availability of guns increases the risk of adolescent suicide
(Brent et al., 1993; King, 2000). The second most common method is
hanging and the third most common is gassing. Males use firearms and
hanging more often than do females, but females use gassing and
ingestion more often than do males for completed suicides (Berman &
Jobes, 1991). The most common method used by suicide attempters is
ingestion or overdose of medicine.

Risk Factors

As noted by Garland and Zigler (1993) and Shaffer and Craft (1999), the
search for the etiology of suicide spans many areas of study. Studies of
counselor awareness of risk factors continue 'to take place (King,
2000). Examples of risk factors that have been studied include
neurotransmitter imbalances and genetic predictors, psychiatric
disorders, poor self-efficacy and problem-solving, skills, sexual or
physical abuse, concerns over sexual identity or orientation,
availability of firearms, substance abuse, violent rock music, divorce
in families, unemployment and labor strikes, loss, disability,
giftedness, and, interestingly, phases of the moon. It is important for
school counselors to note that almost all adolescent suicide victims
have experienced some form of psychiatric illness. The most prevalent
psychiatric disorders among adolescents who have completed suicide
appear to be affective disorders, conduct disorders or antisocial
personality disorders, and substance abuse disorders (Shaffer, 1988:
Shaffer & Craft). Among affective disorders, particular attention should
be paid to bipolar illness and depressive disorder with comorbidity such
as attention deficit disorder, conduct disorder, or substance abuse
disorders (Rohde, Lewinsohn, & Seeley, 1991).

The suicide of a family member or a close friend of the family can also
be a risk factor for youth suicide. Prior attempts also escalate risk
and are still the best single predictors (Shaffer, Garland, Gould,
Fisher, & Trautman, 1988). An adolescent experiencing a physical illness
that is chronic or terminal can also be at higher risk (Capuzzi, 1994).
Many researchers have studied cognitive and coping-style factors (e.g.,
generalized feelings of hopelessness and poor interpersonal
problem-solving skills) as risk factors for youth suicide (Garland &
Zigler, 1993). High neuroticism and low extraversion, high
impulsiveness, low self-esteem, giftedness, disability, and an external
locus of control have also been studied and can be used to predict risk
(Beautrais, Joyce, & Mulder, 1999).

Precipitants

Often, attempted or completed suicide is precipitated by what, to the

adolescent, is interpreted as a shameful or humiliating experience
(e.g., failure at school or work, or interpersonal conflict with a
romantic partner or parent). Mounting evidence indicates that
adolescents who do not cope well with major and minor life events and
who do not have family and peer support are more likely to have suicidal
ideation (Mazza & Reynolds, 1998). The humiliation and frustration
experienced by some adolescents struggling with conflicts connected with
their sexual orientation may precipitate suicidal behavior (Harry, 1989;
McFarland, 1998), although being gay or lesbian in and of itself may not
be a risk factor for suicide (Blumenthal, 1991). Hoberman and Garfinkel
(1988) found the most common precipitant of suicide in a sample of 229
youth suicides to be an argument with a boyfriend, a girlfriend, or a
parent (19%), followed by school problems (14%). Other humiliating
experiences such as corporal punishment and abuse also serve as
precipitants; the experience of sexual or physical assault seems to be a
particularly significant risk factor for adolescent women (Hoberman &
Garfinkel).

Myths

One of the biggest problems connected with youth suicide is the fact
that parents, teachers, mental health professionals, and the adolescent
population itself are not made aware of a variety of myths and
misconceptions associated with this topic. Since subsequent discussion
of best practices for prevention, crisis management, and postvention in
this article is based on prior awareness of this topic, the reader is
referred to Capuzzi and Gross (2000) for a more complete discussion of
the following myths:

• Suicide is hereditary

• Suicide happens with no warning

• Adolescents from affluent families attempt or complete suicide more

often than adolescents from poor families

• Once an adolescent is suicidal, he or she is suicidal forever

• If an adolescent attempts suicide and survives, he or she will never

make an additional attempt

• Adolescents who attempt or complete suicide always leave notes

• Most adolescent suicides happen late at night or during the pre-dawn

hours

• Never use the word suicide when talking to adolescents because using
the word gives some adolescents the idea

• Every adolescent who attempts suicide is depressed.

The Profile

The suicidal profile has been analyzed from the perspectives of both the
practicing counselor or mental health practitioner and that of the
empirically based researcher. Although no constellation of traits and
characteristics has been identified as predictive of suicidal attempts,
a number of experts (Beautrais et al., 1999; Capuzzi, 1994; Capuzzi &
Golden, 1988; Capuzzi & Gross, 2000; Curran, 1987; Davis; 1983; Hafen &
Frandsen, 1986; Hussain & Vandiver, 1984; Johnson & Maile, 1987; Mazza &
Reynolds, 1998) believe that about 90 percent of the adolescents who
complete suicide (and lethal first attempts can result in completions)
give cues to those around them in advance. Whether these cues are
limited or numerous will depend on the adolescent, since each adolescent
has a unique familial and social history. It is important for school
counselors and other school personnel to recognize the signs and
symptoms to facilitate prevention efforts. One of the essential
components of the best practices discussed in a subsequent section of
this article is teaching the profile of the suicidal or potentially
suicidal youth so that referral and intervention can take place.
Behavioral verbal, and cognitive cues and personality traits are the
four areas around which counselors can make observations to base their
assessments of the extent of suicidal ideation and risk. They are
presented below in abridged form. The reader is referred to Capuzzi and
Gross (2000) for more extensive description and discussion.

Behaviors

A number of common behaviors can be noted by counselors and other

practitioners as possible cues: lack of concern about personal welfare;
changes in social patterns; a decline in school achievement; altered
patterns of sleeping and eating; attempts to put personal affairs in
order or to make amends; use or abuse of alcohol or drugs; unusual
interest in how others are feeling; preoccupation with death and
violence themes; sudden improvement after a period of depression; and
sudden or increased promiscuity.

Verbal Cues

As noted by Schneidman, Farbverow, and Litman (1976), verbal statements

can provide cues to self-destructive intentions. Such statements should
be assessed and considered in relation to factors such as behavioral
signs, changes in thinking patterns, motivations, and personality
traits. There is no "universal" language or "style" for communicating
suicidal intention. Some adolescents will openly and directly say
something like "I am going to commit suicide" or "I am thinking of
taking my life." Others will be far less direct and make statements such
as "I'm going home," "I wonder what death is like," "I'm tired," "She'll
be sorry for how she has treated me," or "Someday I'll show everyone
just how serious I am about some of the things I've said."

Thinking Patterns and Motivations

In addition to behavioral and verbal cues, thinking patterns and

motivations of suicidal adolescents can also be assessed and evaluated.
For such an assessment to occur, it is necessary to encourage
self-disclosure to learn about changes in an adolescent's cognitive set
and distortions of logic and problem-solving ability. As noted by
Velkoff and Huberty (1988), the motivations of suicidal adolescents can
be understood more readily when suicide is viewed as fulfilling one of
three primary functions: (a) an avoidance function that protects the
individual from the pain perceived to be associated with a relationship
or set of circumstances; (b) a control function that enables an
adolescent to believe he or she has gained control of someone or
something thought to be out of control, hopeless or disastrous; and (c)
a communication function that lets others know that something is wrong
or that too much pain or too many injuries have been accumulated.

Personality Traits

As previously noted, it would be ideal if the research on the profile of

the suicidal youth provided practitioners with such a succinct profile
of personality traits that youth at risk for suicide could be identified
far in advance of any suicidal risk. Adolescents who fit the profile
could then be assisted through individual and group counseling or other
means. Although no consensus has yet been reached on the "usual,"
"typical," or "average" constellation of personality traits of the
suicidal adolescent, researchers have agreed on a number of
characteristics that seem to be common to many suicidal youth. Among
these are low self-esteem, hopelessness/helplessness, isolation, high
stress, need to act out, need to achieve, poor communication skills,
other directedness, guilt, depression, and poor problem-solving skills.

Best Practices

At the end of the introduction to this article, four questions were

posed that relate to the legal and ethical challenges in counseling
suicidal students. The first three of these questions (What are the
ethical obligations of school counselors and other school personnel once
a youth has been identified as potentially suicidal or attempted or
completed suicide?, What are the roles of faculty, staff, and
administrators, and how do their roles differ from those of the school
counselor or crisis team member?, and How do schools work with parents
and guardians to ensure that an appropriate constellation of services is
provided for a suicidal youth?) are addressed through brief descriptions
of school preparedness for prevention, crisis management, and
postvention.
Prevention

Since a growing number of legal opinions have indicated that

unanticipated acts of violence in schools (and suicide is an act of
violence) can be predicted (Hermann & Remley, 2000), courts, in the
future, probably will expect schools to have prevention programs in
place. If they do not, courts may hold the schools accountable for
suicides. A number of steps must be taken to facilitate a successful
school-community prevention effort. Communication with administrators,
faculty/staff in-service, preparation of crisis teams, providing for
individual and group counseling options, parent education, and classroom
presentations are necessary to fulfill ethical obligations and to
delineate roles.

Communication with administrators. There is a compelling need for

prevention, crisis management, and postvention programs for the
adolescent suicide problem to be implemented in elementary, middle, and
high schools throughout the country (Metha et al., 1998; Zenere &
Lazarus, 1997). One of the biggest mistakes made by counselors,
educators, and coordinators' of counseling/student services is to
initiate suicide prevention programs without first obtaining the
commitment and support of administrators and others in supervisory
positions. Building principals and superintendents must be supportive;
otherwise efforts may not be effective.

In addition to the groundwork that must be done on the building level,

it is also important to effect advance communication and planning on the
district level. The superintendent, assistant superintendent, curriculum
director, staff development director, student services coordinator,
research and program evaluation specialist, must all commit their
support to intervention efforts.

Faculty/staff in-service. Since teachers and other faculty and staff

usually learn of a student's suicidal preoccupation prior to the
situation being brought to the attention of the school counselor or
another member of the crisis team (assuming such a team exists), all
faculty and staff (e.g., teachers, aides, secretaries, administrators,
custodians, bus drivers, food service personnel, librarians, school
social workers) must be included in building or district level
in-service on the topic of youth suicide. All should be taught the
background information previously delineated so that they can make
referrals to the school counselor. It is imperative that all adults in
schools be educated about both youth suicide and building and district
policies and protocols for prevention, crisis management, and
postvention. They must be cautioned against attempting to provide
personal counseling; their roles are to recognize risk and facilitate
referrals. A growing number of publications provide excellent guidelines
for elements of prevention programming focused on school faculty and
staff (Davidson & Range, 1999; Metha et al., 1998; Zenere & Lazarus,
1997).

Preparation of crisis teams. Most schools have crisis teams composed of

faculty, staff, and parents connected with a particular building. These
teams often exist in conjunction with a program for the prevention and
intervention efforts necessary to cope with the drug problem among young
people in today's schools. With education beyond that which is provided
during faculty/staff in-service programs discussed previously as well as
additional supervision and evaluation of clinical skills, a crisis team
can be taught how to facilitate prevention efforts in a school as well
as how to respond to a student already experiencing a suicidal crisis or
in need of postvention efforts.

Individual and group counseling options. Prior to providing students

with any information about suicide and suicide prevention efforts in a
school, arrangements must be made for the individual and group
counseling services that will be needed by those who seek assistance for
themselves or their friends. School counselors rarely have the
opportunity to provide the counseling needed by students identified as
potentially suicidal because of other responsibilities as well as very
high student-to-counselor ratios. Unless such counseling options are
available, any effort at prevention, crisis management, or postvention
will be doomed to failure.

If the school district cannot make a commitment to providing counseling,

then arrangements for referral to community agencies and private
practitioners must be made. It is important to provide adolescents and
their families with a variety of referral possibilities along with
information on fee schedules. There may be some question about whether
the school district will be liable for the cost of such counseling if
the referral is made by the school. (This issue should be explored by
whatever legal counsel is retained by the district.) The dilemma, of
course, is that unless counseling takes place when a suicidal adolescent
has been identified, the probability is high that an attempt or a
completion will take place. If the school is aware of a teenager's
suicidal preoccupation and does not act in the best interests of such a
teenager, families may later bring suit against the district.

Parent education. Parents of students in a school in which a suicide

prevention program is to be initiated should be involved in the school's
efforts to educate, identify, and assist young people in this respect.
Parents have a right to understand why the school is taking such steps
and what the components of a school-wide effort will be. Evening or late
afternoon parent education efforts can be constructive and engender
additional support for a school or school district. Parents have the
same information needs as faculty and staff with respect to the topic of
adolescent suicide.

Classroom presentations. Debate continues surrounding the safety of

adolescent suicide prevention programs 'that contain an educational
component presented to adolescents. This debate is similar to the one
that emerged years ago when schools initiated staff development and
classroom presentations on the topic of physical and sexual abuse. In
conjunction with this debate, a number of advocates of education and
discussion efforts are focused on students in a school-wide suicide
prevention effort (Capuzzi, 1988, 1994; Capuzzi & Golden, 1988; Curran,
1987; Ross, 1980; Sudak, Ford, & Rushforth, 1984; Zenere & Lazarus,
1997). These advocates recommend providing an appropriate forum in which
adolescents can receive accurate information, ask questions, and learn
about how to obtain help for themselves and their friends. They believe
that doing so does not precipitate suicidal preoccupation or attempts
(Capuzzi; Capuzzi & Gross, 2000).

A carefully prepared and well-presented classroom presentation made by a

counselor or member of the school's crisis team is essential. Such a
presentation should include both information on causes, myths, and
symptoms as well as information about how to obtain help through the
school. Under no circumstances should media be used in which adolescents
are shown a suicide plan.

On the elementary level, school faculty should not present programs on

the topic of suicide prevention. Their efforts are better focused on
developmental counseling and classroom presentations directed at helping
children develop resiliency and overcome traits (e.g., low self-esteem
or poor communication skills) that may put them at risk for suicidal
behavior at a later time. Although these efforts should be continued
through secondary education, middle and high school students are better
served through presentations that address adolescent suicide directly.

Crisis Management

School counselors often receive student referrals from other adults in

the building when the student is thought to be experiencing a suicidal
crisis. The principles delineated below are shared for the purpose of
providing succinct guidelines for a suicide-risk assessment so that
steps can be taken to prevent a possible attempt. Any assessment, phone
call, or step taken in this context should be documented in case notes.

Remember the meaning of the term crisis management. When thinking of

crisis management, it is important to understand the meaning of the word
crisis as well as the word management. The word crisis means that the
situation is not usual, normal, or average; circumstances are such that
a suicidal adolescent is highly stressed and in considerable emotional
discomfort. The word management means that the professional involved
must be prepared to apply skills that are different than those required
for preventive or postvention counseling. An adolescent in crisis must
be assessed, directed, monitored, and guided for the purpose of
preventing an act of self-destruction.

Be calm and supportive. A calm, supportive manner on the part of the

intervener conveys respect for the perceptions and internal pain of an
adolescent preoccupied with suicidal thoughts. Remember that such an
adolescent usually feels hopeless and highly stressed. The demeanor and
attitude of the helping person are pivotal in the process of offering
assistance.

Be nonjudgmental. Statements such as "You can't be thinking of suicide,

it is against the teachings of your church," or "I had a similar problem
when I was your age and I didn't consider suicide" are totally
inappropriate during a crisis situation. An adolescent's perception of a
situation is, at least temporarily, reality and that reality must be
respected.

Encourage self-disclosure. The very act of talking about painful

emotions and difficult circumstances is the first step in what can
become a long-term healing process. A professional helper may be the
first person with whom such a suicidal adolescent has shared and trusted
in months or even years, and it may be difficult for the adolescent to
confide simply because of lack of experience with communicating thoughts
and feelings. It is important to support and encourage self-disclosure
so that an assessment of lethality can be made early in the intervention
process.

Acknowledge the reality of suicide as a choice but do not "normalize"

suicide as a choice. It is important for professionals to let
adolescents know that they are not alone and isolated with respect to
suicidal preoccupation. It is also important to communicate the idea
that suicide is a choice, a problem-solving option, not a good choice,
and that there are better choices and options.

Actively listen and positively reinforce. It is important, during the

initial stages of the crisis management process, to let the adolescent
who is potentially at risk for suicide know you are listening carefully
and really understanding how difficult life has been. Being listened to,
heard, and respected are powerful and empowering experiences for anyone
who is feeling at a loss for how to cope.

Do not attempt in-depth counseling. Although it is very important for a

suicidal adolescent to begin to overcome feelings of despair and to
develop a sense of control as soon as possible, the emotional turmoil
and stress experienced during a crisis usually makes in-depth counseling
impossible.

Developing a plan to begin lessening the sense of crisis an adolescent

may be experiencing is extremely important, however, and should be
accomplished as soon as possible. Crisis management necessitates the
development of a plan to lessen the crisis; this plan should be shared
with the adolescent so that it is clear that circumstances will improve.
In-depth counseling cannot really take place during the height of a
suicidal crisis.

Do not do an assessment alone. It is a good idea to enlist the

assistance of another professional, with expertise in crisis management,
when an adolescent thought to be at risk for suicide is brought to a
school counselor's attention. School counselors should ask a colleague
to come into the office and assist with assessment. It is always a good
idea to have the support of a colleague who understands the dynamics of
a suicidal crisis; in addition, the observations made by two
professionals are more likely to be more comprehensive. Since suicidal
adolescents may present a situation that, if misjudged or mismanaged,
could result in a subsequent attempt or completion, it is in the best
interests of both the professional and the client for professionals to
work collaboratively whenever possible. It should also be noted that
liability questions are less likely to become issues and professional
judgment is less likely to be questioned if assessment of the severity
of a suicidal crisis and associated recommendations for crisis
management have been made on a collaborative basis.

Ask questions to assess lethality. A number of dimensions must be

explored to assess lethality. This assessment can be accomplished
through an interview format (a crisis situation is not conducive to the
administration of a written appraisal instrument). Readers are referred
to Capuzzi and Gross (2000) for a complete description of the assessment
process and a list and explanation of the questions. It is important to
understand that the role of the school counselor and crisis team is to
determine if a student is potentially suicidal. Once this determination
has been made, the student should be reassessed by the agency identified
by the school district to make the final decision about the degree of
risk for a suicide attempt or completion.

Make crisis management decisions. If, as a result of an assessment made

by at least two professionals, the adolescent is thought to be
potentially suicidal, the student should be seen by an outside agency.
Under no circumstances should the student be left alone or asked to
return home or meet with a mental health counselor without being
accompanied by a parent or guardian.

Notify parents. Parents of minors must be notified and asked for

assistance when an adolescent is determined to be at risk for a suicide
attempt. Often, adolescents may attempt to elicit a promise of
confidentiality from a school counselor who learns about suicidal
intent. Such confidentiality is not possible or required (Remley &
Herlihy, 2001); the welfare of the adolescent is the most important
consideration.

Sometimes parents do not believe that their child is suicidal. At times,

parents may be adamant in their demands that the school or mental health
professional withdraw their involvement. Although some professionals
worry about liability issues in such circumstances, liability is higher
if such an adolescent is allowed to leave unmonitored with no provision
for follow-up assistance. Schools should confer with legal counsel to
understand liability issues and to make sure that the best practices are
followed in such circumstances. It may be necessary to refer the student
to protective services for children and families when parents or
guardians refuse to cooperate.

Consider hospitalization. Hospitalization can be the option of choice

during a suicidal crisis, if the parents are not cooperating, when the
risk is high. An adolescent who has not been sleeping or eating, for
example, may be totally exhausted or highly agitated. The care and
safety that can be offered in a psychiatric unit of a hospital is often
needed until the adolescent can experience a lowered level of stress,
obtain food and rest, and realize that others consider the circumstances
painful and worthy of attention. The protocol in the school and school
district's written tragedy response plan should be followed in such
circumstances. School counselors and crisis team members should not take
it upon themselves to transport a student to the psychiatric unit of a
local hospital; this should be facilitated by the staff of the agency
the school collaborates with when such circumstances arise.

Refuse to allow the youth to return to school without an assessment by a

mental health counselor, psychologist, psychiatrist, or other qualified
professional. An increasing number of school districts are adopting this
policy. Although it could be argued that preventing a suicidal youth
from returning to school might exacerbate suicidal ideation and intent,
this policy increases the probability that the youth will receive mental
health counseling and provides the school with support in the process of
preventing the youth from engaging in self harm. Acquiring a release
from a third party for a student's return also provides an element of
protection in the event that an attempt or completion takes place at a
later time and the family files a law suit.

Postvention

When an adolescent has attempted or completed a suicide, it is

imperative, particularly in a school setting, for the counselors to be
aware of the impact of such an event on the "system." Usually within
just a few hours, the fact that an adolescent has attempted or completed
suicide has been chronicled through the peer group. This could present a
problem to the faculty and staff in a given school building since not
answering questions raised by students can engender the sharing of
misinformation or rumors. The following guidelines should prove helpful
to school counselors in the process of planning and implementing
postvention efforts:

• The principal of the building in which a student has attempted or

completed suicide (even though such an incident most likely occurred off
the school campus) should organize a telephone network to notify all
faculty and staff that a mandatory meeting will take place prior to
school the next morning. The principal should share information and
answer questions about what happened during such a meeting. In the case
of a suicide completion, it is recommended that the principal provide
all faculty and staff with an announcement that can be read in each
class rather than over a public address system, so that everyone in the
school receives the same information. The announcement should confirm
the loss and emphasize the services the school and community will be
providing during the day and subsequent days. Details about the
circumstances or the family of the deceased should not be given so that
confidentiality is maintained in that regard.

• Faculty and staff should be instructed to answer student questions

that spontaneously arise.

• Faculty and staff should be told to excuse students from class if they
are upset and need to spend time in the office of the building counselor
or another member of the crisis team.
• Parents who are upset by the suicidal incident should be directed to a
designated individual to have questions answered. Parents should also be
provided with options for counseling, whether this counseling is
provided by school personnel or referred to members of the mental health
community.

• At times, newspaper and television journalists contact the school for

information about both the attempt or the completion and the school's
response to the "aftermath." It is important to direct all such
inquiries to a designated individual to avoid the problems created by
inconsistency or sharing inaccurate information.

• Be alert to delayed or enhanced grief responses on the part of

students prior to the anniversary of a suicide completion. Often
students will need opportunity to participate in a support group with
peers or individual counseling prior to and, perhaps, beyond the
anniversary date.

• Do not conduct a memorial service on the school campus after a suicide

because doing so may provide reinforcement to other students preoccupied
with suicidal ideation. This means that it is unwise to conduct an
on-campus memorial service after a death for any reason--it is difficult
to explain why a student who has suicided is not being remembered when
another student, faculty or staff has been memorialized previously.
Excuse students to attend the off campus memorial or funeral. Do the
same thing for deaths for other reasons.

• Early in the sequence of events, one or two individuals from the

school should contact the family and ask if there is any support it
might need that the school can provide. It is a good idea to offer such
assistance periodically, since so many families are left alone with
their grief once the memorial or funeral has taken place.

Additional Considerations

The fourth question posed in the beginning of this article is Can the
school or school district be sued by families after an attempted or
completed suicide? In a pertinent review of the results of school
violence litigation against educators, Hermann and Remley (2000) noted
that, even though school personnel are expected to exert reasonable care
to prevent harm to students, courts have been reluctant to hold
educators liable for injuries related to-violence or self-harm. Usually
state law claims fail because so much of today's school violence (and
suicide attempts and completions are components of school violence)
results from what can be termed spontaneous acts of violence. This
statement should not, however, lull school personnel into a false sense
of security, since a growing number of legal opinions have indicated
that an unanticipated act of violence can be predictable and thus
actionable under state law. Counselors, teachers, administrators, and
other members of school staffs can protect themselves by writing and
implementing prevention, crisis-management, and postvention policies and
procedures for protecting youth from self-harm.

These policy and procedural documents should mandate in-service for

school personnel so that all adults in the school environment recognize
risk factors, myths, and possible behavioral, verbal, cognitive, and
personality indicators as well as role responsibilities and limitations.
Best practices are more likely to be followed if schools take a
proactive rather than a reactive stance to this growing epidemic in our
nation's schools.

Concluding Comments

Because of the legal and ethical considerations delineated in this

article, counselors and other school personnel who are interested in
learning how to identify potentially suicidal youth must obtain more
extensive information than that provided here. In addition, since school
counselors may need to provide follow-up supportive counseling once a
suicidal youth returns to school, school counselors should obtain
supervision from professionals who are experienced in working with
suicidal youth after a suicidal crisis or a suicide attempt. Generally,
prevention, crisis management, and postvention activities should not be
attempted by anyone who has not completed a 2-year CACREP accredited or
CACREP equivalent graduate program. Membership in the American
Association of Suicidology or the American Foundation of Suicidology,
participation in workshops and conferences focused on the topic of youth
suicide, and consistent reading of the Journal of Suicide and Life
Threatening Behavior and other books and journals is imperative so that
best practices are followed in a way that ensures that legal and ethical
standards are integrated into the prevention, crisis management, and
postvention efforts of school counselors.

A youth who becomes suicidal is communicating the fact that he or she is

experiencing difficulty with issues such as problem-solving, managing
stress, and expressing feelings. It is important for school counselors
to respond in constructive, safe, informed ways, because the future of
their communities is dependent upon individuals who are positive,
functional, and able to cope with the complex demands of life.
References

Beautrais, A. L., Joyce, P. R., & Mulder, R. T. (1999). Personality

traits and cognitive styles as risk factors for serious suicide attempts
among young people. Suicide and Life-Threatening Behavior, 29, 37-47.

Berlin, I. N. (1987). Suicide among American Indian adolescents: An

overview. Suicide and Life Threatening Behavior, 17, 218-232.

Berman, A. L., & Jobes, D. A. (1991). Adolescent suicide: Assessment and

intervention. Washington, DC: American Psychological Association.

Blumenthal, S. J. (1991). Letter to the editor. Journal of the American

Medical Association, 265, 2806-2807.

Brent, D. A., Perper, J. A., Moritz, G., Baugher, M., Schweers, J., &
Roth, C. (1993)..Firearms and adolescent suicide: A community
case-control study. American Journal of Diseases in Children, 147,
1066-1071.

Bush, J. A. (1976). Suicide and Blacks. Suicide and Life-Threatening

Behavior, 6, 216-222.

Canetto, S. S., & Sakinofsky, I. (1998). The gender paradox in suicide.

Suicide and Life-Threatening Behavior, 28, 1-23.

Capuzzi, D. (1988). Counseling and intervention strategies for

adolescent suicide prevention. (Contract No. 400-86-0014). Ann Arbor,
MI: ERIC Counseling and Personnel Services Clearinghouse.

Capuzzi, D. (1994). Suicide prevention in the schools: Guidelines for

middle and high school settings. Alexandria, VA: American Counseling
Association.

Capuzzi, D., & Golden, L. (Eds.). (1988). Preventing adolescent suicide.

Muncie, IN: Accelerated Development.

Capuzzi, D., & Gross, D. (2000). "I don't want to live": The adolescent
at risk for suicidal behavior. In D. Capuzzi & D. Gross (Eds.), Youth at
risk: A prevention resource for counselors, teachers and parents(3rd
ed., pp. 319-352). Alexandria, VA: American Counseling Association.

Curran, D. E (1987). Adolescent suicidal behavior. Washington, DC:

Hemisphere.

Davidson, M. W., & Range, L. M. (1999). Are teachers of children and

young adolescents responsive to suicide prevention training modules?
Yes. Death Studies, 23, 61-71.

Davis, P. A. (1983). Suicidal adolescents. Springfield, IL: Charles C.

Thomas.

Garland, A. E, & Zigler, E. (1993). Adolescent suicide prevention:

Current research and social policy implications. American Psychologist,
43, 169-182.

Gibbs, J. T. (1988). Conceptual, methodological, and sociocultural

issues in Black youth suicide: Implications for assessment and early
intervention. Suicide and Life-Threatening Behavior, 18, 73-79.

Hafen, B. Q., & Frandsen, K. J. (1986). Youth suicide: Depression and

loneliness. Provo, UT: Behavioral Health Associates.

Harry, J. (1989). Sexual identity issues. Report of the Secretary's Task

Force on Youth Suicide: Vol. 2. Risk factors for youth suicide (DHHS
Publication No. ADM 89-1622). Washington, DC: Government Printing
Office.

Hermann, M. A., & Remley, T. E, Jr. (2000). Guns, violence, and schools:
The results of school violence--litigation against educators and
students: Shedding more constitutional rights at the school house gate.
Loyola Law Review, 46, 389-439.

Hoberman, H. M., & Garfinkel, B. D. (1988). Completed suicide in

children and adolescents. Journal of the American Academy of Child and
Adolescent Psychiatry, 27, 688-695.

Hussain, S. A., & Vandiver, K. T. (1984). Suicide in children and

adolescents. New York: SP Medical and Scientific Books.

Johnson, S.W., & Maile, L. J. (1987). Suicide and the schools: A

handbook for prevention, intervention, and rehabilitation. Springfield,
IL: Charles C. Thomas.

King, K. A. (1997). Suicidal behavior in adolescence. In R. W. Maris, M.

M. Silverman, & S. S. Canetto (Eds.), Review of suicidology (pp. 61-95).
New York: Guilford.

King, K. A. (2000). Preventing adolescent suicide: Do high school

counselors know the risk factors? Professional School Counseling, 3,
255-263.

King, K. A. (2001). Tri-level suicide prevention covers it all.

Education Digest, 67, 55-61.

Mazza, J. J., & Reynolds, W. M. (1998). A longitudinal investigation of

depression, hopelessness, social support, and major and minor life
events and their relation to suicidal ideation in adolescents. Journal
of Suicide and Life-Threatening Behavior, 28, 358-374.

McFarland, W. P. (1998). Gay, lesbian, and bisexual student suicide.

Professional School Counseling, 1(1), 26-29.

Metha, A., Weber, B., & Webb, L. D. (1998). Youth suicide prevention: A
survey and analysis of policies and efforts in the 50 states. Suicide
and Life-Threatening Behavior, 28, 150-164.

National Center for Health Statistics. (1992). Advance report of final

mortality statistics. NCHS Monthly Vital Statistics Report, 40(6).
Hyattsville, MD: Author.

National Center for Health Statistics. (1996). Advance report of final

mortality statistics, 1994. NCHS Monthly Vital Statistics Report, 45
(Suppl. 3). Hyattsville, MD: Author.

Popenhagen, M. P., & Qualley, R. M. (1998). Adolescent suicide:

Detection, intervention, and prevention. Professional School Counseling,
1(1), 30-35.

Remley, T. E, Jr., & Herlihy, B. (2001). Ethical, legal, and

professional issues in counseling. Upper Saddle River, NJ:
Merrill/Prentice Hall.

Rohde, P, Lewinsohn, P, & Seeley, J. R. (1991). Comorbidity of unipolar

depression: Comorbidity with other mental disorders in adolescents and
adults. Journal of Abnormal Psychology, 100, 214-222.

Ross, C. (1980). Mobilizing schools for suicide prevention. Suicide and

Life-Threatening Behavior, 10, 239-243.

Schneidman, E., Farbverow, N., & Litman, R. (1976). The psychology of

suicide. New York: Jason Aronson.

Shaffer, D. (1988). The epidemiology of teen suicide: An examination of

risk factors. Journal of Clinical Psychiatry, 49, 36-41.
Shaffer, D., & Craft, L. (1999). Methods of adolescent suicide
prevention. Journal of Clinical Psychiatry, 60, 70-74.

Shaffer, D., Garland, A., Gould, M., Fisher, P., & Trautman, P. (1988).
Preventing teenage suicide: A critical review. Journal of the American
Academy of Child and Adolescent Psychiatry, 27, 675-687.

Speaker, K. M., & Petersen, G. J. (2000). School violence and adolescent

suicide: Strategies for effective intervention. Educational Review, 52,
65-73.

Sudak, H., Ford, A., & Rushforth, N. (1984). Adolescent suicide: An

overview. American Journal of Psychotherapy, 38, 350-369.

Velkoff, E, & Huberty, T. J. (1988). Thinking patterns and motivation.

In D. Capuzzi & L. Golden (Eds.), Preventing adolescent suicide (pp.
111-147). Muncie, IN: Accelerated Development.

Wyche, K., Obolensky, N., & Glood, E. (1990). American Indian, Black
American, and Hispanic American youth. In M. J. Rotheram-Borus, J.
Bradley, & N. Obolensky (Eds.), Planning to live: Evaluating and
treating suicidal teens in community settings (pp. 355-389). Tulsa:
University of Oklahoma.

Zenere, E J., III, & Lazarus, E J. (1997). The decline of youth suicidal
behavior in an urban, multicultural public school system following the
introduction of a suicide prevention and intervention program. Suicide
and Life-Threatening Behavior, 27, 387-403.

~~~~~~~~

By David Capuzzi

David Capuzzi, Ph.D., LPC, is a professor and coordinator, Counselor

Education, Graduate School of Education, Portland State University, OR.

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