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

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.