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    The McMaster Department of Philosophy has now put together the following notice commemorating Barry: Barry Allen: A Philosophical Life Barry…

The tragedy of student suicide

Brian Leiter

MOVING TO FRONT FROM YESTERDAY–UPDATED

This bracing and tragic NYT story about a student at Hamilton College should be read by all college teachers.   The awful situation in which those local know that a student is in distress but the parents do not results from student privacy laws that, quite mistakenly, treat teenagers (and those barely out of their teens) as adults (even, ironically, when parents are footing the bill for everything).  The privacy laws need to be changed so that parents or guardians can be kept apprised of health issues their children face.  Even more importantly, faculty need to be alert for students having problems and be proactive in referring them to support services available at the institution.  The tremendous improvements in treatments for what otherwise would have been disabling mental health conditions a generation ago means that more of our students today are in high risk categories.

UPDATE:  A faculty member at another university tells me they have been advised by legal counsel that "If we feel that you are in imminent danger to your self or others we are empowered to break confidentiality."  In addition, he points me to the FERPA rules which contain this exception:

Health or Safety Emergency

In some situations, a school may determine that it is necessary to disclose non-directory information to appropriate parties in order to address a disaster or other health or safety emergency. FERPA permits school officials to disclose, without consent, education records, or personally identifiable information from education records, to appropriate parties (see Q&A 9) in connection with an emergency, if knowledge of that information is necessary to protect the health or safety of the student or other individuals. See 34 CFR §§ 99.31(a)(10) and 99.36. This exception to FERPA’s general consent requirement is temporally limited to the period of the emergency and generally does not allow for a blanket release of personally identifiable information from the student’s education records.

Under this health or safety emergency provision, an educational agency or institution is responsible for making a determination whether to make a disclosure of personally identifiable information on a case-by-case basis, taking into account the totality of the circumstances pertaining to a threat to the health or safety of the student or others. If the school district or school determines that there is an articulable and significant threat to the health or safety of the student or other individuals and that a party needs personally identifiable information from education records to protect the health or safety of the student or other individuals, it may disclose that information to such appropriate party without consent. 34 CFR § 99.36. This is a flexible standard under which the Department defers to school administrators so that they may bring appropriate resources to bear on the situation, provided that there is a rational basis for the educational agency’s or institution’s decisions about the nature of the emergency and the appropriate parties to whom information should be disclosed. We note also that, within a reasonable period of time after a disclosure is made under this exception, an educational agency or institution must record in the student’s education records the articulable and significant threat that formed the basis for the disclosure and the parties to whom information was disclosed. 34 CFR § 99.32(a)(5).

I'm opening comments for those with more experience and/or information about the emergency exception and also about practices at other institutions.

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24 responses to “The tragedy of student suicide”

  1. Christopher Hitchcock

    I suspect the statement about breaking confidentiality concerns reporting to university offices, and not to the student's parents. We are instructed that if a student comes to us in distress that we should inform the student that we may be required to report to one or another university office if we think the student may be a threat to themselves or others, or if we think that a crime has been committed. There are specific people on campus (e.g. therapists at the counseling center) who can maintain confidentiality, and we can refer students there if they want to confide in someone without the risk of disclosure.

    Reply
  2. Christa

    There’s variation between states. After the Virginia Tech shooting, Virginia law requires schools notify parents when students receiving mental health treatment are deemed at significant risk of suicide.

    https://parenthandbook.virginia.edu/policies/parent-notification

    Reply
  3. No disclosure, no way

    I am emphatically against any mandatory reporting to student's parents, for several reasons:

    (1) It assumes that parents are either supportive of or understanding of or emotionally equipped to handle mental health issues. This may not be the case, and it is possible that a student has good reasons not to report their mental health problems to their parents, who might very well make things worse by putting pressure on their child or saying that 'it's all in your head'.

    (2) It assumes that parents are uniquely equipped to meet their child's needs, which is not often the case. Many teens and young adults commit suicide even while living at home, even when parents do everything they can to help their son or daughter. This isn't to say that some parental support can't be helpful, but only that it shouldn't be expected that parents are especially capable of preventing their child from committing suicide.

    (3) From my experience, if a student is in distress or seems depressed or is even openly suicidal, the only thing professors are morally required to do (not sure about legal requirements) is to suggest or report that student to counseling services. The problem with this is that for larger schools these services are often overwhelmed with appointments, and a student with pressing needs might not be able to get an appointment for at least a month. This is a problem for the university.

    (4) One somewhat independent worry is that expressing serious suicidal ideation or intent to school counselors might require them to institutionalize the student. This is often a good thing, especially if an appointment to get medication is weeks away and a student needs immediate help. This isn't a decision to be taken lightly, however, as the student will get further behind on work (which may be one source of their distress) and they might have to disclose their hospitalization/condition to professors. While most professors will probably be understanding, it might be that there are subtle differences in the way they treat you afterwards — they might pity you, wonder if you can handle the work, be uncomfortable interacting with you normally etc. It's reasonable to think that these possible consequences are worth it, if it means that a life is saved.

    Many of the above concerns also apply to serious mental health issues other than (severe) depression, like mania, psychosis, eating disorders, etc.

    Reply
  4. Brian Leiter

    Perhaps students should have the option of opting out of emergency notifications. But absent clear evidence I see no reason for thinking that barring parental notice works out better for students in crisis. Indeed, as you note, many schools may not have adequate mental health resources, all the more reason to bring parents into the picture.

    Reply
  5. No disclosure, no way

    Maybe I am wrong about this, but I don't think there is any policy that *bars* parental notification. Mental health professionals often suggest that students notify their parents; it's just that they can't legally do so without the student's consent. The relevant question is about *mandatory* reporting, which it seems that what the Barton's are asking for. Obviously they are grieving, but there are good reasons to keep the reporting system as it is, and work on improving knowledge of and access to mental health services.

    Reply
  6. Brian Leiter

    What are the "good reasons" not to have the emergency exception, as FERPA appears to? What is the evidence supporting this? Is there any? These are genuine questions, maybe someone has answers. But, again, speculation about *maybe* parents won't help is neither here nor there; after all, *maybe* parents will help and be far more proactive than institutions, which seems rather likely. Has anyone studied this? What about outside the US, what are the rules? Are there fewer student suicides in countries without stringent privacy protections?

    Reply
  7. No disclosure, no way

    Ok, let me try to make this clear. There are at least two options:

    (1) The general protocol is to report health issues (including mental) to parents, allowing exceptions according to the judgment of professionals. This seems to be Virgina's law, as above (a kind of mandatory reporting law).

    (2) The general protocol is not to report health issues to parents, allowing students to opt in (non-mandatory reporting). This is the current standard.

    I favor current standards, (2). You want a change to (1), according to your initial post. In your most recent post however, you seem to favor (2).

    Good reasons against (1):

    — Some parents suck, as a matter of fact. It's better to assume that students over the age of 18 know what's best for themselves, not a third party.
    — Parents are not especially equipped to make their kids not depressed. They can't do anything in particular that couldn't be done by people at the university — namely, getting them to go to a therapist/psychiatrist. Related to the first reason, some parents don't agree with psychiatry/therapy.

    One of the reasons that (1) is no longer adopted is for reasons other than mental health, though these considerations certainly apply. Prior to current standards, a health professional could report to a student's parents if she had health complications from an abortion, for example. Not so great if the parents are staunchly anti-abortion. Some people (still!) go to university to distance themselves from whatever environment they grew up in, for all kinds of reasons.

    Reply
  8. Brian Leiter

    I'm not sure Virginia's approach is the best one, so, yes, I favor (2). However, FERPA is often taken by colleges to block (2): students aren't asked to "opt in" to reporting. What is important is that there be an emergency exception that overrides FERPA.

    Some parents suck. How many? We've no idea, but a reasonable supposition is that the vast majority will be better at looking out for the interests of their children than an institution.

    How many 18 year olds know how to look out for themselves? How many 18 year olds with mental health problems know how to do this? I'd venture not a lot.

    In any case, real evidence would be welcome, if there's any out there.

    Reply
  9. Howard

    I think students with mental health issues might lack the judgment to opt out of parental notification. Definitely, if they're psychotic- if they are depressed or suicidal, they might feel very isolated and ambivalent about getting help or contact with other people- I think the schools can have oversight over students, without violating rights- this is a grey area and people get caught in the cracks. The system isn't made for the neediest among us, even if it is affluent or privileged youth

    Reply
  10. Dean C. Rowan

    The response to question 9 in the Q&A portion of the FERPA document to which Brian links states, "Typically, law enforcement officials, public health officials, trained medical personnel, and parents (including parents of an eligible student) are the types of appropriate parties to whom information may be disclosed under this FERPA exception."

    Reply
  11. JDF

    Ignoring potential privacy concerns, one reason against a POLICY of informing parents would be that there is evidence that students suffering from mental health issues will be less likely to seek help if they think/know that their parents will/might be informed. I don't know whether there is such evidence, but many people suffering from depression are embarrassed about it and don't want people, especially people close to them, to know about it. If they don't strongly believe that their sessions and diagnosis will be kept in confidence, they might not seek professional help at all. At least, this type of argument is often presented in discussions of mandatory reporting laws about other things (e.g., mandatory parental notice/consent for minor's abortions, mandatory reporting by psychiatrists/therapists of pedophiles who have never acted on their sexual attraction to children).

    Reply
  12. Kristian

    Lecturer and therapist here.

    This is what I think would be ideal, not necessarily what is legal at present.

    1. The school should occasionally break confidentiality. Florid psychosis or mania are good cases. Sometimes those illnesses hit fast, the parents don’t know, and they could help, and the student has lost the capacity to make reasonable choices about whether they want to reach out to their own parents. In those cases, notifying would usually be best.

    2. A teacher should never break confidentiality, on their own, obviously. Leave it up to the higher ups who can consult psychologists and lawyers. Knowing when and how to break confidentiality is really, really complicated. You need training and experience that teachers don’t have. Ask your chair for help, the dean of students, someone above you, because you don’t know what you’re doing.

    3. In cases where the student remains reasonable, the school could ideally confront them with choices. “Are you sure you don’t want to get your mom’s help? Why?” If the answer is reasonable, e.g. “they beat me and will kill me if they find out I’m gay” or “I don’t want them in my life like that” then the school respects the decision. If they say, “Don’t tell them, they are spies for the evil others,” you can contemplate confidentiality breaks. Involving the parents if the student is adamant (but not psychotic) is a violation of their confidentiality and won’t help things any way.

    Reply
  13. Kristian

    I should add that if the student is not psychotic and doesn’t want the parents to help, and we break confidentiality to get their help, it seems very unlikely they’ll be able to help. If you suggest the student tell a parent and they adamantly refuse, they do not perceive their parent as helpful and possibly as harmful (a little or a lot.) These perceptions are often accurate (unless the student is psychotic) and we need to listen to them.

    Sadly, Brian, I think many parents are not helpful and are often harmful.

    Just my opinions.

    Reply
  14. Brian Leiter

    Thank you for your perspective. I do want to caution that, even given your experiences, we should not conclude that "many parents" are unhelpful, let alone that most are. I've no doubt some are the source of the problem. But as a parent, I've no doubt that our investment in our children's well-being is greater than that of any of the (fine and very admirable) institutions they have studied at.

    It would be great to hear from others like Kristian on the "front lines" as it were.

    Reply
  15. Kristian

    Sorry to be unclear. I mean to say that many parents whose children perceive them to be unhelpful or harmful really are unhelpful or harmful. (As long as those children are not psychotic.) It is an empirical question that I take no stand on if all or most or many parents overall are helpful.

    These kids have 18 years of experience with their parent. If they actively say they don't want to contact their parents and they are not psychotic and are reasonable, they need to be listened to.

    My opinion anyway.

    Reply
  16. harry b

    I appreciate Kristian's advice. Many students have confided in me that they have serious depression and anxiety, and my first reaction is to try to convince them, gently, to get professional counseling. In some cases I have been successful, in some not. One barrier to success is the health care system itself. Our university health services has a limit of 8 counseling sessions per student and there is no guarantee they will all be with the same counselor — indeed, it is extremely unlikely that they will all be with the same counselor. The experiences of my students who have gone to University Health Services, in fact, have made me uneasy about recommending it — I continue to do so because the instructions I get from the dean of students are very clear, but I do not feel good about it (its not that I think the counselors to immediate harm, but I worry that their experience will put them off counseling for life). Most students' parents have health insurance but, especially if they are working class, they are extremely reluctant to use it, because i) the out of pocket fees are large enough that they don't want to impose that cost on their parents and ii) they don't want their parents to know they are getting counseling because they don't want to face the questioning (I've had several students, eg, who really really do not want their parents to know they have been raped). This is not (usually) because they don't like or don't feel loved by their parents — or even because they perceive them to be unhelpful/harmful — but because they don't want to upset/disappoint them.

    Only one of the many students mentioned above came close to suicide, and that was before she began confiding in me. (Many years later she is now a healthy, confident, and well-balanced young woman, with,as she says "the problems that normal people have"). For almost all the others, I think it would have helped them if their parents had known what was going on, but it would not have helped them if the way their parents learned what was going on was through me, someone they trusted with their confidences. If I ever had reason to believe that suicide was a real possibility I would go to the dean of students and would hope that confidentiality would be breached, but would be very glad that it is not a choice for me to make.

    Reply
  17. No disclosure, no way

    harry b raises a great point here. Even if you're right Brian, that the vast majority of parents will be maximally helpful and not harmful, I think there's a general underestimation of how much kids typically don't want to disappoint their parents. Thus they might have a general concern that being depressed or anxious means they couldn't hack it, and so don't want to crush the (often high) expectations of their parents.

    What's striking to me is that one of the students, Kong, was in physical contact with her parents the days before her death. Even the Hamilton student's parents knew that he was distressed. They just weren't aware of the depth.

    Reply
  18. Brian Leiter

    As far as I can tell, everyone here agrees about the importance of the emergency exception, and its propriety, and that's the only point I want to insist on. Again, I suggest caution in generalizing based on only anecdotes about how many kids do or do not want to disappoint their parents, or share their problems with them, etc. No doubt there is variation.

    Reply
  19. Rebecca

    I wonder if it would make sense for schools to ask in advance for an (optional) emergency contact for situations like this. Lots of employers ask for this for physical health emergencies. Perhaps if students had a chance to note a possibly different trusted other in case a mental health issue arose, they might list an uncle or high school mentor or older sibling, eg, if their parents aren't the ones they'd trust and want to turn to in a crisis. That might help make the emergency exception more fruitful in more cases.

    Reply
  20. harry b

    Yes, I certainly agree about the emergency exception; unless there is some very compelling research showing it would be on balance harmful (I doubt it would be and don't see, given the current state of things, and the way IRBs behave, how anyone could do a study that would get us compelling evidence either way. Part of the question is what constitutes an emergency and how to identify it. At schools like mine (much larger and more anonymous than Hamilton, but still basically residential) the challenge is getting students to talk to someone so they know what is going on — identifying the emergency in the first place.

    Reply
  21. Mark Engleson

    Why are universities such a special case? Why not have all sorts of institutions contacting the parents of legal adults?

    Reply
  22. Brian Leiter

    Most college students are not over the age of 21. And colleges operate in loco parentis in multiple respects *unlike* most employers.

    Reply
  23. V. Alan White

    One reminder for profs who read threats of harm/self-harm in papers and are compelled to make copies for records and reports–I have done this several times–please shred them when the issue is resolved (fortunately in my cases, with no bad outcomes).

    Reply
  24. Ben

    This is very correct. Here at the University of Nairobi, we have the department of the Dean of Students which best placed to handle matters that very personal and then refer cases to counselors.

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