Legal and ethical challenges in counseling suicidal students - Special issue: legal and ethical issues in school counseling

Professional School Counseling, Oct, 2002 by David Capuzzi

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).