A school counselor calls the ASCA office concerned about a colleague who conducted a suicide investigation, found a child not suicidal, and sent her home on the school bus. A mother is distraught when her daughter is named as her friend's "safe person" in a suicide contract. An administrator calls in after the suicide of a student whose disturbing journal entries weren't identified as suicidal.
These are just a few examples of questions received by the ASCA Ethics Committee that reflect everyday occurrences in the life of school counselors.
Suicide is the third leading cause of death among 15-24 year olds. According to a 2010 study by the Centers for Disease Control and Prevention, 13.8% of American high school students had seriously considered suicide in the past 12 months, and 6.3% said they had attempted suicide during that time . School counselors often get the first outcry; However, there is still confusion as to what action to take. Reviewing court decisions after student suicide makes sense from the dual and distinct perspective of legal requirements and ethical norms.
Eisel vs. Montgomery County Board of Education
Legal Analysis: In Eisel vs. Board of Education of Montgomery County (1991), a 13-year-old college student died in an apparent murder-suicide pact with another college student. Her father sued the school district and two of its school counselors, arguing that his special relationship with his daughter placed him and his wife under a duty to report suicidal thoughts. The lower court dismissed the father's claim. However, on appeal, the Maryland Supreme Court sent him back to the lower court for trial. The appeals court cited the foreseeability of the harm as a key factor in determining whether school officials were required to warn the student's parents. Ultimately, the lower court jury ruled that the school counselors were not responsible for the student's death. However, the Eisel case provided some critical insights.
Ethical review: In the Eisel case, the court recognized that school counselors hear a lot about suicidal thoughts and that not all threats are substantive; however, "so great is the consequence of risk that even a relatively small possibility of suicide may be sufficient to establish a duty" (Eisel v. Board of Education of Montgomery County, 1991). School counselors act in loco parentis, meaning that it is their duty to protect the safety of students at school and to use reasonable care to give parents the opportunity to protect their children.
The ASCA Ethical Standards for School Counselors require school counselors to “recognize that working with minors in a school environment requires school counselors to work with the student's parent/guardian as much as possible. Sometimes students cheat to avoid another exam and/or parental notification,” so we played it safe. When school counselors work with a potentially suicidal student, the end result should always be to notify the parent/guardian.
School counselors consult and are constant consumers of legal and ethical information and seek help from school peers, administrators, and attorneys. The complexities of the legal world are less daunting and security is increased by consulting with other professionals.
Post-Eisel case law on negligence with immunity from civil liability
Legal Analysis: Several instances of malpractice following a student's suicide have occurred since the Eisel decision, but the reasons and results fit the general pro-educator pattern. Regardless of the action or inaction of the school counselor, in many states, government immunity serves as an effective defense for the school district and officials. For example, in Killen vs. Independent School District #706 (1996), a ninth grader killed herself with a gun in her home. Although the school counselor advised the parents that their daughter had expressed suicidal thoughts and recommended counseling, the parents claimed that the school counselor did not inform them when the daughter later made a more specific statement about suicide. The Minnesota Court of Appeals upheld the lower court's dismissal based on the government's immunity provisions.
Likewise in Grant v. Board of Trustees of Valley View School District (1997), Friends of a student told the school counselor about his suicidal thoughts and drug overdose. The school counselor urged the mother to take him to a hospital for drug treatment. Later that day, the student jumped to his death from an overpass. Her mother claimed the school counselor didn't tell her about her suicidal expressions. An Illinois appeals court upheld the lower court's dismissal, contending that public schools and their employees enjoy immunity unless their misconduct was willful or arbitrary.
Ethical Review: School counselors speak to parents about a child's explicit or tacit suicidal thoughts. When a student makes thinly veiled threats of suicide, school counselors avoid raising the issue; Instead, they ask the difficult questions. Many suicidal students want an end to their suffering, not their life, and answer "no" when asked if they are considering suicide. However, this answer does not eliminate the risk. Use open-ended questions like "What do you think about life and death?" This approach can serve as the first step in getting an at-risk student the help they need. Parents need to understand that utterances of suicide or other warning signs require vigilance. School counselors should document that they contacted the parents and, if possible, have a witness to the conversation. The school principal or other administrator can add leverage and urgency to the conversation when parents are reluctant to act. School counselors use their best judgment in these emotionally charged situations and avoid prioritizing documentation over the parents' feelings and well-being. However, ask for a parent's signature at the first appropriate opportunity.
Post-Eisel jurisprudence without state immunity
Legal Analysis: Even where a state does not have applicable state immunities, wrongdoing claims have also been largely unsuccessful. A federal appeals court upheld the dismissal of a suit brought by the mother of an eighth grader who hanged herself (Scott v. Montgomery County Board of Education, 1997). The school psychologist met with the student about two months before his death and assessed him as not directly self-harmful and did not inform the student's parents. The court came to the conclusion that the alleged causal connection with the school psychologist was not sufficient and that the mother's allegation of neglect was not to be classified as an educational error.
A Wisconsin appeals court found that the parents' action failed for lack of an essential element of a negligence action—causality—(McMahon v. St. Croix Falls School District, 1999). In this case, a student from the school was absent and died of self-immolation. One of her classmates claimed that she told a school counselor that he was planning to skip class and that he said something about being "suicidal." The Wisconsin Court of Appeals ruled in favor of the school's defendants because suicide is an intervening variable under Wisconsin law that "breaks the line of causality."
In Mikell vs. School Management Unit #33 (2009), a student allegedly told a teacher's assistant that he "wanted to blow his brains out." The school counselor met with the student, informed the parents that the student could remain at school, and had the student sign a "safety agreement." The school counselor did nothing, and two months later the student hanged himself. The New Hampshire Supreme Court ruled that the school authorities were not responsible for the student's death because they did not have custody of the student as they would at a hospital, nor did they engage in "extreme and outrageous" behavior that the "resulted in an uncontrollable urge to commit suicide or prevented the deceased from realizing the nature of his act".
Armijo vs. Wagon Mound Public Schools (1998) is the only published decision recognizing a Section 1983 cause of action against school authorities for the suicide of a student. A New Mexico school principal suspended a student and ordered a school counselor to escort him home. His parents returned home later that day to find him dead from a self-inflicted gunshot wound. Earlier in the day he reportedly told a school assistant that he might be "better off dead". The Tenth Circuit Court of Appeals allowed the case to proceed because a jury was able to determine that the principal and counselor left him at home alone with access to a firearm when they knew he was having suicidal thoughts. The final outcome of this case was not released, and the school district (the deepest pocket) was the accused, not the school counselor.
Ethical Review: School counselors find little comfort in the courts' reluctance to try school counselors and their districts in relation to student suicide. School counselors want to avoid defending their lawsuits in court, but more importantly, they want to avoid the death of a student. It's daunting to worry about all the issues that crop up in a school counselor's day-to-day life, but suicide is one of those commitments that needs to be prioritized for immediate attention. A student's statement "tired and tired of life" is reason enough to trigger immediate action. "In adolescence, indirect cues may be offered through jokes or references in schoolwork, particularly creative writing or artwork." Children seeing the world concretely may not know how to express these feelings verbally or in writing.
If a school counselor conducts a suicide analysis, informally or formally, and determines that the student is at low risk of suicide, the school counselor must still contact the student's parents. ASCA's ethical standards require that school counselors "report risk assessments to parents when they emphasize the need to act on behalf of an at-risk child." If you tell the parent that you have spoken to their child and believe that it is okay for the child to stay in school, the parent will likely perceive their child as having a low risk of suicide.
Another controversial practice is the development of student suicide contracts by school counselors, as in the Mikell case. There is little empirical evidence that contracts are an effective tool for suicide prevention. In addition, the use of a suicide contract implies that the school counselor is keeping the student safe. The word "contract" can give the impression of a binding agreement. However, a suicidal person is often unable to consent to signing a contract. Using suicide contracts can have the opposite effect and lead to legal action. If a school counselor believes it is in the student's best interest to put something down on paper, ask the student any goals, comments of hope, what is working right now, or which adult to ask for help.
Well-meaning school counselors may enlist a close friend of the student as a helper and identify that person as such in a non-injurious contract; However, this can overwhelm a colleague with feelings of responsibility for the life or death of another student. Making students aware of what to do if a friend shares this information is a more effective part of school suicide prevention plans. The Armijo decision deserves special attention. The school counselor had to convince the principal that, given the child's emotional state, the best course of action would be to wait until the student could be placed in the protective custody of his parents, which is far more important than immediate punitive action. Taking or sending home a very agitated or emotional child without parental supervision is a dangerous practice.
It is important for school counselors to have a supportive counseling network in place long before they actually need it. When working with students at risk of suicide, school counselors should make best efforts to provide counseling recommendations to parents/guardians until placement is secured for that student. School counselors need to be culturally sensitive when working with families to provide additional help. When school counselors and crisis team members encounter unresponsive parents, they may need to hand over control to other agencies, e.g.
Schools act responsibly when they have suicide prevention and intervention plans with regular services to prepare all educators—teachers, administrators, security guards, cafeteria workers, janitors, bus drivers, secretaries, support staff, and service workers—on procedures for referral of suicidal students for help .
Parents were rarely able to establish responsibility for the student's suicide, and none of the known decisions resulted in an educator being held accountable. Of course, there may be unpublished cases or agreements to the contrary, and case law may change in the future. While the precedents to date greatly reduce any undue fear of school counselor liability, awareness of the legal rationale behind court decisions serves as a guiding principle for school counselors when making decisions that may save student lives in the future. Framing the best practice discussion around the court's arguments gives school counselors the opportunity to apply the court's judgments to their practice.
Eisel and the ensuing lawsuits provided school counselors with powerful and prophylactic lessons regarding suicidal students. School counselors, with their specialized training and status as local parents, have a high standard of care when a student's suicide is a remote possibility. School counselors should always reach out to parents and direct them to the appropriate resources that will enable them to seek help for their child. Confidentiality trumps the death of a child. Calling Parents upholds school counselors' most important commitment to students: first and foremost, do no harm.
Carolyn Stone, Ed.D., is an Associate Professor at the University of North Florida and Chair of the ASCA Ethics Committee. She can be reached at firstname.lastname@example.org. Perry A. Zirkel, J.D., Ph.D., is Professor of Education and Law at Lehigh University and can be reached at email@example.com. For references please contact the authors.
What are the ethical issues of suicide? ›
The ethical principles most relevant when considering a suicidal patient include autonomy or self-determination, informed consent, duty to protect, beneficence, nonmaleficence, and confidentiality.What factors will you need to consider when conducting a suicide assessment? ›
- Prior suicide attempt(s)
- Misuse and abuse of alcohol or other drugs.
- Mental disorders, particularly depression and other mood disorders.
- Access to lethal means.
- Knowing someone who died by suicide, particularly a family member.
- Social isolation.
- Chronic disease and disability.
Abstract. Studying the contents of suicide notes might help to improve the understanding of individual cases whilst offering an opportunity to search for possible preventive guidelines.What are the causes of suicide among learners? ›
Things that increase the risk of suicide among teens include: a psychological disorder, especially depression, bipolar disorder, and alcohol and drug use (in fact, about 95% of people who die by suicide have a psychological disorder at the time of death) feelings of distress, irritability, or agitation.What are some ethical issues in mental health? ›
- Diagnosis. ...
- Researcher participant relationship. ...
- Involuntary treatment. ...
- Electroconvulsive therapy. ...
- Confidentiality. ...
- Informed consent. ...
- Conflict of interest. ...
- Depression, other mental disorders, or substance use disorder.
- Chronic pain.
- A history of suicide attempts.
- Family history of a mental disorder or substance use.
- Family history of suicide.
- Exposure to family violence, including physical or sexual abuse.
- Presence of guns or other firearms in the home.
The five-step assessment includes identification of risk and protective factors; conducting an inquiry about suicidality; determining level of risk and selecting an appropriate intervention; and documenting the process, including a follow-up plan.What is the ultimate goal of a suicide assessment? ›
Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors.Which assessment tool is used for suicide? ›
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a standardized suicide risk screening tool validated for use with children, adolescents, and adults. It assesses for both passive and active suicidal ideation, method, plan, intent to act on the plan, and suicidal behavior.Why is suicide an important social issue? ›
Suicide is among the 10 leading causes of death in the US and has the potential to suddenly change many lives. It often occurs when people are disproportionately affected by societal conditions, including inequities, discrimination, oppression, and historical trauma.
Why is suicide prevention important in schools? ›
Why Address Suicide Prevention. Maintaining a safe school environment is part of your school's overall mission. Students' mental health can affect how well they perform in school. Suicide can affect the entire school community.How do you educate a suicidal person? ›
Help them to connect to support services. This may include dialing the National Suicide Prevention Lifeline number for them to talk to a trained counselor. If this is too much for the person, encourage them to text the Crisis Text Line on 741741. Support them to make and attend a doctor's appointment.How does education affect suicide? ›
Among males with only secondary school or no education the cumulative suicide risk is 3.5 times higher than among females with the same level of educational attainment (Table 2). The gap is smallest for those with a university degree with the suicide risk for males 2.2 times higher than females.How common is student suicide? ›
The suicide rate for college students is reportedly 7 per 100,000 or approximately 1,100 individuals annually. Suicide is the second most common reason for death among college students.What students are at a higher risk of suicide? ›
Young people who experience extreme anger or have a history of aggressive, impulsive behavior face higher suicide risks. Strong feelings themselves aren't the sole cause, since most children and teens experience intense emotions and moods.What are the legal issues in mental health? ›
- Confidentiality and right to privacy.
- Health Insurance Portability and Accountability Act (H I P A A) ...
- Doctrine of privileged communication.
- Exceptions: A duty to warn; suspected child or elder abuse. ...
- Informed consent. ...
- Restraints and seclusion. ...
- False imprisonment.
- Informed consent. ...
- Confidentiality. ...
- Multiple relationships. ...
- Termination of therapy.
Unethical accounting, harassment, health and safety, technology, privacy, social media, and discrimination are the five primary types of ethical issues in the workplace.What is the key to preventing suicide? ›
Everyone can help prevent suicide by learning the warning signs, promoting prevention and resilience, and a committing to social change. CDC's Suicide Prevention Resource for Action highlights strategies based on the best available evidence to help states and communities prevent suicide.Is suicide prevention a social justice issue? ›
In a new article published in the Journal of Prevention and Health Promotion, Counseling Psychology Professor Emeritus John Westefeld of the University of Iowa College of Education, describes how we can begin to understand suicide and suicide prevention as a social justice issue.
What are three suicide prevention strategies? ›
Crisis hotlines, standardizing mental health care, and restricting lethal means are all saving lives.What are the 3 parts of a suicide risk assessment? ›
Trauma: Current and past physical, sexual, or emotional abuse and/or trauma. Triggering Events: Factors, stressors, or interpersonal triggers, especially those leading to humiliation, shame, despair, or loss. Ideation: Presence, duration, and severity of thinking about death or ending life.What four elements make up the suicide prevention program? ›
The following four elements of a care continuum must be included in any community's suicide prevention design: (1) screening and assessment for suicide risk, (2) intervention (safety planning, means restriction), (3) treatment responses (including direct treatment or referral depending on the setting and degree of risk ...What are the 3 main components of the interpersonal theory of suicide? ›
The Interpersonal Theory of Suicide currently seems to be the most popular theory in suicidology. It posits that suicide can be explained by the simultaneous presence of three risk factors only, namely acquired capability for suicide, thwarted belongingness, and perceived burdensomeness.What are the levels of suicide? ›
They are (1) totally non-suicidal, (2) suicide ideation [fleeting], (3) suicide ideation [chronic], (4) suicide-like gesture, (5) diffuse risky lifestyle, (6) suicide plan [vague, non-lethal], (7) suicide plan [specific, lethal], (8) non-serious [low-lethality] suicide attempt, (9) serious [high-lethality] suicide ...What is the most important predictor of suicide? ›
Suicide attempt predictors in the general population include functional impairment and financial crisis, a machine learning model suggests.What is one of the primary goals of suicide Postvention? ›
A goal of suicide postvention is to prevent suicide among people who are at high risk after exposure; safe communication is a key prevention strategy. Messaging must not glorify or idolize the person who died by suicide, sensationalize the death, or provide details about the cause of death (Brock, 2003).What are 10 questions to ask during a suicide assessment? ›
- Passive suicidal thoughts. Do you wish you didn't have to go on living?
- Active suicidal thoughts. Do you have thoughts of wanting to take your own life?
- Suicidal threats. Did you talk about killing yourself with others?
- Suicide Plans. Have you thought about methods to kill yourself?
- Decision. ...
- Details. ...
- Resistance. ...
Objective: The Columbia- Suicide Severity Rating Scale has become the gold standard for the assessment of suicidal ideation and behavior in clinical trials.Who does suicide risk assessment? ›
Your primary care provider or a mental health provider may also use one or more suicide risk assessment tools. A suicide risk assessment tool is type of questionnaire or guideline for providers. These tools help providers evaluate your behavior, feelings, and suicidal thoughts.
What social factors affect suicide? ›
There is growing evidence that social factors, including education, employment status, income level and wealth, play an important role in determining the risk of suicide in high income countries (Blakely et al, 2003). A combination of factors contribute to someone considering suicide.What is suicide and its types? ›
Durkheim identifies four different types of suicide which are egoistic suicide, altruistic suicide, anomic suicide and fatalistic suicide. Egoistic suicide is seen as stemming from the absence of social integration. It is committed by individuals who are social outcast and see themselves as being alone or an outsider.What are the social causes of suicide? ›
- Family/loved one's history of suicide.
- Loss of relationships.
- High conflict or violent relationships.
- Social isolation.
However, the report does state that out of the 10,732 youngsters under the age of 18 years, who died by suicide, 864 were because of 'failure in examination.” The largest cause of suicide in this age group (of under 18 years) was “family problems.”What should schools do after a suicide? ›
Notify the School Crisis Team and develop a plan. If initial notification occurs outside of school hours, this may require initiating the phone tree or alternate communication system to notify the school staff and to have them meet before school to organize a unified plan and to brief school staff.How does education affect the mental health of students? ›
Research shows that academic stress leads to less well-being and an increased likelihood of developing anxiety or depression. Additionally, students who have academic stress tend to do poorly in school. This shows how this stress can keep kids from doing as well as they could.Does the level of education influence completed suicide? ›
Persons with higher school attainment, compared with those with a maximum primary school degree, had significantly increased odds ratios of dying from a suicide rather than a natural cause. For persons aged 65-74 years or above, however, the differences were not so much obvious.Do schools differ in suicide risk? ›
A poor school rating was associated with a significant increase in the odds of suicide-risk by age 15 (OR 1.65, p = 0.016).What is the leading cause of suicide in college students? ›
In a recent national survey 16% of college students reported being diagnosed with a depressive disorder, many within the last year. Over 90% of persons who commit suicide have a diagnosable mental disorder, typically a depressive disorder or substance abuse disorder.In which country students suicide rate is highest? ›
- Lesotho - 72.4.
- Guyana - 40.3.
- Eswatini - 29.4.
- South Korea - 28.6.
- Kiribati - 28.3.
- Federated States of Micronesia - 28.2.
- Lithuania - 26.1.
- Suriname - 25.4.
What is the leading cause of death in college students? ›
Suicide is a leading cause of death among college and university students in the United States. 1,2 In addition, many other college and university students have suicidal thoughts and attempt suicide.What factors put students most at risk today? ›
- Poor school attitude.
- Low ability level.
- Behavior/discipline problems.
- Drug abuse.
- Poor peer relationships.
Suicide is the #2 leading cause of death for college students. Approximately 1,100 suicides on college campuses per year.
The presence of mental illness is one of the strongest risk factors for suicide1. Studies indicate that between 70 and 91 per cent of young people who attempt suicide or report suicidal thoughts have a mental illness2.What are the issues of suicide? ›
Suicide has far-reaching impact. Suicide and suicide attempts cause serious emotional, physical, and economic impacts. People who attempt suicide and survive may experience serious injuries that can have long-term effects on their health. They may also experience depression and other mental health concerns.What is the social perspective of suicide? ›
Suicide is a deeply intimate, personal act and at the same time the most individual act. At its core, suicide is also a social phenomenon because it is a consequence of the disturbed relationship between the individual and society. As a problem, suicide has occupied society for many centuries.What is society's attitude towards suicide? ›
Attitudes include not only how society feels about those who kill themselves but the family members who are left behind as well. Although surveys have shown that many Americans see suicidal people as psychologicalCy disturbed, some groups argue that suicide can be seen as a rational behavior.How does the law define suicide? ›
Suicide is the intentional taking of one's own life. This case from Maryland, explains that “suicide is the intentional taking of one's own life, i.e., by his or her own hands.”What are social factors of suicide? ›
There is growing evidence that social factors, including education, employment status, income level and wealth, play an important role in determining the risk of suicide in high income countries (Blakely et al, 2003). A combination of factors contribute to someone considering suicide.What are ethical issues and implications? ›
Ethical Implications can include, but are not limited to: Risk of distress, loss, adverse impact, injury or psychological or other harm to any individual (participant/researcher/bystander) or participant group. Benefit to the individual (eg. Financial, reputational) Privacy concerns or issues (eg.
What are some ethical dilemmas for students? ›
- Do I have to conform? ...
- Do I pick a major based on passion or post-graduate salary? ...
- Do I have to adhere to “hookup culture”? ...
- How do I live with someone else? ...
- Do I party?
Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from rape, stealing, murder, assault, slander, and fraud. Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty.What are the 4 types of suicide? ›
to Durkheim, there were four different types of suicide: egoistic, altruistic, anomic, and fatalistic. The types of suicide created by Durkheim suggested that suicide was more or less likely to occur due to levels of regulation by society and the level of integration of the individual in society.How do you approach a suicide topic? ›
- Ask "Are you thinking of killing yourself?" (While people may be hesitant to ask, research shows this is helpful.)
- Keep them safe. Reduce access to lethal items or places.
- Be there with them. Listen carefully and acknowledge their feelings.
- Help them connect. ...
- Stay connected.
limit access to the means of suicide. interact with the media for responsible reporting of suicide. foster socio-emotional life skills in adolescents. early identify, assess, manage and follow up anyone who is affected by suicidal behaviours.What cultural factors influence suicide? ›
- Family and Other Social Support. ...
- Religion and Religiosity. ...
- Cultural Values and Suicide. ...
- Economic Influences and Socioeconomic Status. ...
- The Political System.
- Know the facts. Educate yourself about mental illness including substance use disorders.
- Be aware of your attitudes and behaviour. ...
- Choose your words carefully. ...
- Educate others. ...
- Focus on the positive. ...
- Support people. ...
- Include everyone.