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

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.