Stopping Suicide 101The dilemma of college students who threaten to kill themselves.

George Washington University has taken a serious beating lately. In fall 2005, the university was sued by a former student named Jordan Nott, who was barred from campus after seeking hospital care for severe depression and thoughts of suicide. In March, after the university responded in court to Nott's complaint, the Washington Post ran a front-page whammy about the case, followed by a blistering editorial called "Depressed? Get Out!" The blogosphere was not any kinder to the school. Time weighed in with a more balanced piece about Nott's case and others last week. The Chronicle of Higher Education featured a lengthy Q & A with a campus suicide expert.

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Nott and other students who've had similar experiences say they're being punished for seeking help and discriminated against because they have a mental health disability. Since universities are legally prohibited from telling their version of events—because of the Family Educational Rights and Privacy Act—it's tricky to know exactly what's going on in these cases. But don't be too quick to judge the schools. Potential suicides put them in a serious bind. On the one hand, it obviously constitutes discrimination to suspend every Zoloft-taker. On the other hand, keeping suicidal students on campus can compromise the well-being of other students and potentially open up schools to lawsuits from parents. Schools aren't necessarily wrong to take a tough stand. And in fact, some quasi-disciplinary measures may be in a suicidal student's best interests.

The Jordan Nott case is one of a growing number of situations in which students say they were wrongly forced off-campus. Nott says that in the fall of 2004, he was haunted by a close friend's suicide and suffering from severe depression. Frightened by his own thoughts of death, late one night he checked himself in to George Washington University Hospital. Shortly thereafter, he was barred from campus and told that the university had initiated disciplinary action against him because his "endangering behavior" violated the school's code of conduct. Nott's central contention is that by disciplining him in this manner, GWU violated his civil rights under the Americans With Disabilities Act and other laws.

The school's approach to Nott was not warm and fuzzy, to be sure. And as recent rulings by the Department of Education's Office of Civil Rights make clear, a student should not be removed from school unless he is shown to pose a "direct threat" to himself or others and is given a chance to appeal the decision. But we don't know the details of Nott's medical treatment or the discussions that led up to the school's action. For argument's sake, if Nott's depression was caused by his friend's suicide, which occurred on campus the previous spring, an administrator might have believed it was in his best interests to take time away. Two additional GWU students had committed suicide in the previous six months, so the school was legitimately worried about copycat deaths.

GWU also may have had reason to rely on its disciplinary code in handling a potentially suicidal student—to stay on the right side of disabilities law. The law permits schools to crack down on disruptive or violent behavior, but not, of course, to punish underlying conditions or disabilities. Thus, the school may have settled on "endangering behavior" as a general ground for taking action. That might not fit with the facts in Nott's case, since Nott denies that he attempted suicide or had a suicidal plan. But we just don't know. GWU may have chosen to rely on its disciplinary system because it provided a well-tested set of procedures, and in theory thus complied with the due process requirements of disability law.

In the 1970s and 1980s, when the courts and university culture overwhelmingly favored the protection of individual rights and autonomy, schools were more likely to treat students as adults. For example, if a student threatened or attempted suicide on campus, administrators rarely called his or her parents. But baby-boomer parents have demanded greater oversight from schools. After MIT student Elizabeth Shin set herself on fire in her room and died in 2000, her parents expressed outrage that the school had obeyed their daughter's wishes and decided not to call them in the days preceding her death, despite signs that her depression was worsening. Shin's parents sued, and MIT, like GWU, was flogged in the press.

Shin's case also alarmed universities across the country because it suggested that administrators who are not therapists might be held liable for failing to prevent a student's death. Gary Pavela, director of judicial programs at the University of Maryland, worries that schools are overreacting to such preliminary rulings. The only directly relevant decision by an appeals court points in the opposite direction, he notes. In Jain v. Iowa, in 2000, the Supreme Court of Iowa held that administrators who knew about a student's previous suicide attempt were not liable for his death. Nonetheless, there is a widespread sense that the legal ground is shifting and uncertain. Schools naturally want to play it safe, given the enormous potential liability of a student death, not to mention the dreadful publicity.

There are a growing number of mentally-ill students on campuses today, thanks in part to the success of psychotropic drugs, which allow more troubled students to get to college and to do well there. According to the Jed Foundation, an organization that focuses on campus suicide prevention, there are also 1,100 annual student suicides. It's hard to generalize about whether potentially suicidal students are better off on campus, with school resources and possibly less access to guns, or at home, away from academic stresses and closer to family. The decision should probably be made case by case.

But one successful program, under way for 20 years at the University of Illinois, is a model because it complies with disabilities law, reduces school liability, and helps students all at once. Illinois does not treat suicide as a "victimless crime" or a cry for help, but rather as an unacceptable act of violence. Students who threaten or attempt suicide are required to attend four assessment sessions, in which they are asked to respond to questions regarding the events, thoughts, and feelings that led up to the suicide threat or attempt. If they refuse to participate, they can be removed from school. But the goal is to keep students enrolled. The school acts like the student's adversary, but in the interest of getting him help. And though it's not required, many students who participate in the program go on to receive therapy. Of the 2,000 students who have gone through the program in two decades, only one has been forced by the school to withdraw. (Others chose to withdraw or were persuaded to withdraw voluntarily.)

The Illinois program is the only university suicide-intervention effort that has been studied empirically, according to Paul E. Joffe, chair of the school's suicide-prevention team. The results are impressive. The school's suicide rate is roughly half of what it was before the program was implemented, and roughly half of the current rate for other Big Ten schools. And Illinois is arguably reducing its liability by responding aggressively to every known suicide threat or attempt.

So far, MIT and other schools have beefed up counseling services rather than follow Illinois' example. GWU says that by fall, it will no longer treat suicidal behaviors as disciplinary infractions. These changes are fine. But they don't add up to the kind of scientifically validated program that Illinois has pioneered. Schools should keep in mind that sometimes tough treatment is good medicine.

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