Abstract

Suicide, or the act of deliberately ending ones own life, is considered a public health problem.
The statitiscs shows that an average of 3,000 individuals commits suicide daily. For each
effective occurrence, 20 or more individuals attempt it (World Health Organization. 2011).
According to the Centers for Disease Control and Prevention, suicide is the third cause of death
in the United States among individuals between 15 and 24 years, as cited by Appelbaum (2006).
In Puerto Rico, according to statistics offered by the Heath Department, in 2008 there were 299
suicides, which represent a rate of 7.5 for every 100,000 Puerto Ricans. (Instituto de Estadsticas
de PR, 2010)
Every year in the United States, approximately 1,100 college students between the ages of 18
and 24 commit suicide, and nearly 24,000 attempt it (Appelbaum, 2006). A four-year prospective
study done in the United States with freshman college students revealed that 12% had suicidal
ideation sometime during their years at college (Wilcox, Arria, Caldeira, et al., 2010).
Since the 80s, counseling center directors in the United States have been participating in an
ongoing survey every two years. The survey is sponsored by the Association for University and
College Counseling Center Directors. Since 2005, data from this survey reveals an increase of
students that exhibit severe mental health problems and seek help through the counseling centers
(Gallager, 2009).
Similarly, literature on the issue in Puerto Rico indicates that suicidal ideation and suicidal
behavior are more frequently detected in students that seek help through the university
counseling centers (Jimnez, 2009).
On the occurrence of behaviors associated with suicide, there are some studies that indicate that
one out of every five suicides among college students occur the same day they are having a life
crisis (Appelbaum, 2006). This finding points to the importance of not only investigating more
deeply every aspect of the various behaviors associated with suicide, but also the way in which
individuals think about this phenomenon.
Although suicide is an extremely important topic, its discussion in Puerto Rican society is very
limited, particularly when it has to do with suicide among young persons. Campos, Padilla, and
Valerio (2004)indicate that this is because individuals avoid and prefer not to face the fact that
some young individuals think life is that painful and are killing themselves in a conscious and
deliberate manner. This fact has an impact on and partially questions our social and family
system.
Although research on mental health and behaviors associated with suicide among college
students is scarce in Puerto Rico when compared to what has been published in the United
States, a study done with the students of the University of Puerto Rico (UPR) indicated that
15.4% of surveyed students reported depressive symptomatology on a self-assessment scale
(Reyes & Surez, 2006). On the other hand, statistics from 2005 to 2009 at the Interdisciplinary
Center for Student Development at the UPR-Cayey Campus (CEDE, for its acronym in Spanish)
indicate that depressive symptoms were the most frequent problem among students serviced at
the center through individual counseling.
Mental health research suggests the need to work on suicide prevention and intervention at
universities, so that strategies can be developed to prevent suicide, fight against the stigma of
seeking help, and promote wellbeing among college students. However, at the University of

Puerto Rico (UPR) no systematic activities were in place to prevent suicide outside the clinical
and therapeutic setting. This changed since 2006, when the Substance Abuse and Mental Health
Services Administration (SAMHSA) awarded a grant to the UPR-Cayey Campus to develop a
program on suicide prevention in the university context. Another 29 universities in the United
States and a private university in Puerto Rico also received the SAMHSA grant to develop this
type of program.
This paper presents and discusses the process of developing and implementing the Suicide
Prevention Program among college students (SPP) that was developed at the University of
Puerto Rico- Cayey Campus (UPR-Cayey) as a result of the collaboration with SAMHSA. The
model we developed is collaborative in nature, which means that the aspect of prevention
involves every sector of the university. As part of the experience, we implemented two key
strategies to develop a successful collaborative model in the university setting: 1) Ask every
sector to participate as advisors/collaborators in the development of prevention strategies; and 2)
use culturally appropriate language to minimize the stigma associated with mental health
problems. Below we will describe these strategies and the importance of using culturally
sensitive models for suicide prevention among college students.
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Development of the Suicide Prevention Program (SPP)

The Suicide Prevention Program (SPP) implemented at the UPR-Cayey was the first federally
funded initiative in the University of Puerto Rico system to address this problem. The UPRCayey is a public liberal arts institution that grants undergraduate degrees. It is located in the
central part of the island of Puerto Rico and has approximately 3,300 students enrolled. It is also
part of a system composed of eleven campuses with approximately 59,000 students.
Goals and Objectives of the SPP
At the campus, the main goals with the SPP were the development of a campaign directed at
providing information and increasing awareness in the academic community about suicide and
its prevention. In addition, our intention was to reduce the stigma associated with seeking help
for mental health services. Our objectives were: a) to develop an emergency management and
response plan; b) to prepare educational material; and c) to create a webpage about who could
seek help, and when, where and how to seek it. During the Programs planning and
implementation process, it was important to start thinking about the particularities of our
universitys students, faculty and staff, and our universitys culture. Various lessons and
successful practices, which can be useful to other programs, were the product of this process of
reflection. Following we present the process which led to the development of the SPP.
Initial Phase: Coordinate and offer training about the topic to students, faculty
and staff
The first step in developing the campaign was to coordinate training sessions offered by local
experts on the topic of suicide. These conferences were directed at mental health professionals
working at the counseling centers (counselors and psychologists) from the eleven campuses of
the UPR system. These trainings were extremely valuable for the eventual planning of
prevention activities at the UPR-Cayey Campus.

During these meetings, we gathered information about everyones daily experiences working at
the counseling centers. For example, we explored experiences related to intervention with
students with mental health issues. Meeting participants also shared their experiences and
interventions with suicidal crises. One important aspect identified was the fact that none of the
centers had developed a crisis protocol, which was necessary. Another aspect was the importance
of integrating every component of the academic community in the prevention of suicide. To
accomplish this we needed to develop strategies because the main problem was that the academic
community was not involved and only relied on professionals at the counseling center for suicide
prevention. We were interested in learning how other colleague counselors in the UPR system
perceived the role of other community members (faculty, staff, students) in promoting wellness
and prevention.
It became quickly evident that we were confronting similar situations. For example, students
participation in workshops was scarce. Typically, students do not attend activities that are not
related to their courses, or their attendance is very limited. We needed to develop strategies that
would stimulate student participation in the different activities.
Another common experience was the challenge of getting professors to refer students to the
counseling centers. We knew that professors were probably the first ones to notice in students the
need to receive counseling and that it was important for them to participate in our discussions.
However, given their multiple and complex responsibilities, colleagues informed that getting
them to coincide for a meeting or training was very difficult.
In addition to receiving training and sharing with other colleagues during this initial phase of the
project, we also reviewed various training models available through the internet and aimed at lay
persons on how to educate about suicide prevention. We chose the Question, Persuade and Refer
model (QPR). This strategy was chosen because it is recognized as an evidence-based practice
(Quinet, 2000). We would also be able to get a certification on the intervention by completing
modules and taking online courses, and without having to travel outside the country. In addition,
the reasonable cost of being trained as instructors would allow us to train and certify an
unlimited amount of gatekeepers and it included various materials and books for us and for the
gatekeepers. Another advantage was that the gatekeepers training could be offered with a certain
amount of flexibility, making it culturally appropriate and completely adjustable to our
population and to the availability of our participants.
Second Phase: Develop the Question, Persuade and Refer (QPR) Training
The QPR is based on the premise that talking about death at a personal and group level allows
individuals to get more awareness of the signs that a persons woh is thinking about suicide shows
and where to refer for help. (Quinnett, 2000). Using this model as a foundation, our team
designed and adapted a one-and-a-half-hour workshop, which offers general information about
the prevalence of suicidal behavior in our students and discusses some myths about the topic. We
adapted the training according to participants time availability, but always including the key
elements: talk and ask questions to the person at risk for suicide, persuade them to seek help and,
if needed, refer the person to professional help.
The emphasis of this workshop was on the importance of having the participation of the entire
academic community in suicide prevention among college students. The student in need decides
who he talks to about this (for example, it could be another student, a professor, or a staff
person). This is why it was so important to train the entire academic community. When designing
the workshop for professors, for example, we emphasized the fact that, in addition to the idea of

dying, there could be indicators of anguish and hopelessness. Another objective for the
professors training was to share information about how to identifify students who might be
considering the idea of taking their lives. We also presented and modeled strategies to persuade
an individual to seek help and offered information about referral resources.
Once the QPR workshop was adapted, the team was challenged with the task of implementing it
to train every sector of the academic community.
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Strategies to Educate and Disseminate Information About the Issue

We identify two key elements to educate and disseminate information about the important facts
about suicide and about actions that can be taken in those cases. The first key element is to
recruit every part of the academi community to become consultants. The second key elemnt is to
use culturally adequate language to reduce the impact of stigma on students. In the next section
we elaborate about these elements.
Key Element #1: To Recruit Every Part of the Academic Community to Become
Consultants
Talking about students mental health is typically seen as a matter pertaining exclusively to the
counseling centers and we wanted to initiate a dialogue about this topic with every sector. To
increase participation, we had to come up with diverse alternatives.
Counselors and Psychologists
One of the most significant contributions of this experience was to include this group as
consultants and collaborators. Although we work for the same system, as a professional group we
have very limited opportunities to meet and share our experiences working in an academic
context. Response from this group was excellent, 95% of those invited came to the meeting.
The participation of the counselors and psychologists who work at the UPR-Cayey was a key
element to this project. We were the first ones to meet and participate in formal training on the
topic, including the certification as QPR instructors. The Program covered the cost of the
certification. It also paid stipends so that the staff could participate in meetings for brainstorming
and strategy development in the areas we wanted to develop to address the issue of suicidal
behavior. First, the need to promote services and the process of referral and intervention in atrisk cases was identified as an area to improve. As a product of these meetings, this group of
colleagues came up with a slogan to promote the Counseling Center (CEDE) within the
academic community. This slogan had to be attractive for students, which are our clientele. The
slogan was: Your challenges are not only academic. When it gets tough, let us help you. It was
included in posters and the CEDE promotional materials and this is how the CEDE promotional
campaign started. The staff also collaborated in developing the intervention protocol for
individuals at risk of suicide and the initial screening of referred students. In addition, the Center
started a registry of the suicide risk cases addressed. The experience of pairing the Centers goals
with the goals of the Suicide Prevention Program was a key element in establishing practices that
are still being implemented even after federal funding has ended. The fact that the promotional
strategies and the intervention protocols were a product of the group working at the CEDE and
were not adopted from an external entity contributed to their rapid implementation at the CEDE
and contributed to the dissemination and permanence of the campaign at the university.

Students
We met with the presidents of every student organization and asked for their collaboration in
getting the students to participate in the SPP. We did this because we knew that it was easier for a
student to talk about his/her worries with another student than with an adult, even if it is a mental
health specialist. We decided to train every member of the student organizations free of charge to
become collaborators or gatekeepers in suicide prevention. These students took the training and
obtained a certification as gatekeepers. Their role was to collaborate with the program in
detecting signs of suicidal risk in other students and knowing how to persuade them to seek help
and refer them. When presenting this proposal to them, we emphasized their abilities and
leadership skills. In addition, we asked them for ideas to develop strategies for suicide prevention
in addition to the ones presented during the training or before receiving the training. We made
emphasis on the fact that, as peers, they could be key elements in identifying at-risk students.
As a result, some student organizations developed activities in which they combined preventive
action with academic content. For example, a student from the undergraduate math program
decided to write a paper for her Statistics course where she explained various concepts using
suicidal behavior rates by age and gender and compared them by geographical region. These
groups also had the idea of holding a suicide prevention day. One of the activities during the day
was that students asked their professor to use 5 minutes in class to read facts about the topic of
suicide and promote among students the use of counseling services when they had difficult
challenges to deal with. Another student organization prepared a mural with the slogan Laugh,
Live and Love, to promote among students expressions of their reasons to be alive. Through
these and other strategies, we had an impact on 90% of the students participating in student
organizations.
Staff
Coordinating staff assistance for the training sessions was one of the most successful. It was
coordinated for security officers and secretaries. In both cases, we presented them with the
possibility of a workshop and emphasized on how their role as part of the academic community
allowed them to identify special situations among students early on. We think that the emphasis
we made on their vantage point for detecting and referring contributed to a greater participation
in the workshops. Security officers explained that because they are always present on campus,
they observe students in their daily interactions and can identify mood states, sometimes way
before counseling professionals who are in their offices. In addition, secretaries pointed out that
because they have daily contact with many students who come to ask questions and seek help
with academic issues, sometimes they got students who talked with them about daily worries and
problems. Both security officers and secretaries felt that their role allowed them to identify and
refer students that needed additional help. The Human Resources office included the topic of
suicide prevention among the topics offered periodically to employees for professional
development.
Another group that was included as consultant and that was especially productive was the
Graphic Arts division and its personnel. This division was a key player in designing the local
campaigns creative concept. One of the suggestions they made was to develop posters with short
messages, complemented with images or photos. They also contributed by using individuals
from the academic community as models, which attracted attention towards the posters and, of
course, towards the campaign.

Teaching personnel
With the professors, we were successful in getting some time during a faculty meeting, where we
indicated that we wanted to get their opinions and recommendations about the strategies we had
developed in the prevention campaign. We were not able to get a time allocated for offering a
workshop or training. It was extremely useful to get professors involved as consultants, given
their experience with students and their particular competencies. This strategy increased interest
in the issue of suicidal conduct. Professors contribution to the process was to approve the
strategies we were using. The opportunity of talking with professors about our interest in suicide
prevention and letting them know that everyone in the academic community could contribute
was aimed at stimulating them to collaborate in identifying students who could be at-risk and
refer them or guide them to seek help. We started to receive referrals from professors and we
even had professors who personally brought students to the Center.
The dialogues with the various sectors of the academic community helped discover ways in
which everyone could contribute, participate or generate strategies for suicide prevention.
Counselors contributed their experience and a strategy to promote the Counseling Centers
services was developed with them. The strategy included a slogan for the Counseling Center, a
web page and an emergency protocol. The slogan and the promotional messages were developed
taking into account suggestions students had given, including to use messages related to stress
generating situations in academic life and to avoid pathologizing jargon. Our campaign was
characterized by using culturally appropriate language for college students. When we talked
about this with professors and staff, they indicated that given the type of scenarios in which they
offer their services, this would facilitate interaction with the students and help detect indicators
that a student might need help. In the next section, we will explain these consultation processes
in detail.
Findings of the Consultation Process
Discussion groups held with colleague counselors and students took place at the University. We
invited counselors to come to a meeting that was held in a non-working day with the purpose of
brainstorming to produce strategies for suicide prevention. We provided a stipend for
participating. With students, we coordinated meetings with theater students and with the leaders
of the student organizations to present the Suicide Prevention Program and ask for ideas on how
they thought the campaign could be more effective. In both cases, an open question format was
used. The questions were designed to explore the main problems affecting students wellbeing.
These discussion groups developed from the Project Directors interest in working in a
collaborative manner and developing culturally appropriate and relevant products.
A very interesting aspect of these dialogues was that participants perceived the university as a
scenario that stimulates competence and goal attainment, which consciously or unconsciously
inhibits people from showing their vulnerabilities. Students informed that this culture of
competition could generate excessive stress and anxiety. Our University has high admission
standards. For this reason, some students find it difficult to let others see them as vulnerable or
incapable of meeting academic demands. In addition, there was consensus among participating
academic community members on the fact that in Puerto Rico there is prejudice against persons
who visit a mental health professional.
Some students reported being preoccupied with being identified as a mentally sick person as a
result of visiting a mental health professional. Studies indicate that mental health has a stigma in
society (Mateu & Cuadra, 2007). In Puerto Rico there has also been some research done on the

stigma associated with prejudice against individuals who visit a psychologist or other mental
health professionals (Varas & Cintrn, 2007). For us it was evident, particularly when exploring
students perspective, that we needed to overcome the clinical paradigm of suicide prevention as
an individual matter that only pertains the individual with suicidal behavior and in which only
the mental health professional intervenes.
From our experience at the CEDE and from the dialogues held with other colleagues, we knew
that the general attitude in the academic community was to delegate suicide prevention and
intervention exclusively to the Universitys mental health professionals. In order to recruit every
sector of the academic community, this perception had to be changed. In addition, a collaborative
approach that included every member of the academic community in the efforts made to prevent
suicide had to be implemented. That is to say, far from assuming the clinical construction of what
mental health problems are, we wanted to examine which were the typical problems that students
faced and if their lack of skills to manage them could increase the risk of suicidal behavior.
During group discussion with students, we explored the typical problems and life events that can
affect their performance and sense of wellbeing, driving them to consider suicidal behavior. They
informed various difficult events that can generate distress in college students, such as: (a)
romantic breakups; (b) rejection because of sexual orientation; (c) problems at home; (d) stress
related to studying and working at the same time; (e) being a parent; and (f) depressed mood. We
validated this knowledge, which was based on their experiences. This was particularly relevant
because there is local and international research that supports the relationship between suicidal
ideation and negative life events (Adams & Adams, 1996; Rosello & Berrios, 2004;). There is
research that identifies romantic breakups as the most important cause of suicidal behavior in
young persons (Drum, Brownson, Burton, & Smith, 2009). Similarly, research on the topic
indicates that difficulties related to feeling discriminated or rejected due to sexual orientation can
also be a risk factor for suicide (Silenzio, Pena, Duberstein, Cerel, & Knox, 2007).
The dialogues and collaborative experiences with the various groups of collaborators from the
academic community were extremely productive in generating ideas and strategies, mainly
because they helped us to broaden our information with a cultural perspective. That is to say, if
our program was aimed at young college students at the undergraduate level, most of them raised
in the central part of the Island, it was important to try to know and understand their
particularities. Similarly, we wanted to understand their worldview and to see how it differed
from our own. This was especially important because we are professional adults and come from
a different cultural group. We recommend that the visual materials take into consideration
culturally relevant symbols and metaphors, actors and models.
Key Element #2: Use Culturally Adequate Language to Reduce the Impact of
Stigma on Students
Following we present some of the ways we implemented the findings obtained through
discussion groups, workshops and dialogues.
Slogan
We decided that the Suicide Prevention Program campaign should use non-biased language that
did not contribute to stigma-generating conceptions. This required us to focus on difficulties
inherent to the academic experience and the developmental stage where most part of the students
were, as well as on the challenges they must deal with. Taking this into account, one of the first
actions that this strategy generated was the development of a slogan to promote among students

the practice of seeking help. The slogan selected was: Your challenges are not only academic.
When it gets tough, let us help you. This slogan was culturally appropriate and did not use
pathologizing or stigma-generating language. This was achieved by framing students problems
as challenges; which empowers the student. This slogan states that academic life is much more
than acquiring academic competences or skills. It is a time in life in which the individual is also
facing other personal, economic, family and relational matters, which can produce stress and are
potentially dangerous for the persons stability and wellbeing. In this slogan, we invite the person
to visit the mental health specialists at the Counseling Center, which emphasizes help and
support instead of diagnosis and treatment of a particular condition.
Posters
With the information we had about the typical problems students face, we prepared posters
representing the situations described by them. The models used for the posters were students,
employees and a professor from our University.
One of the contributions of the collaborative approach to the development of the prevention
campaign was the language used to name the typical problems students face, without using
traditional DSM IV categories. For example, in one of the posters, the image of a visibly sad
young man is accompanied by the word rocheao. In English, the meaning of this word would
be similar to that of bummed out. Young people use this word to describe a sad or anguished
emotional state. This type of word is common among young Puerto Ricans language. Including
this word intended to connect with them. On the other hand, including members of the academic
community in the posters resulted in a very effective element for bringing attention to the posters
and to the message.
Webpage
Students perspective on the topic also contributed to the development of a webpage for the
Counseling Center (which was part of the objectives of the PPS). During the process of
designing the webpage, a very talented freshman reviewed the pages of prevention programs in
other universities. As a result, she decided that in building our page she should focus on the
challenges students face and not on the deficits. According to this student, in her review, she
found that some pages included instruments to screen for depression, panic attacks and eating
disorders, among others. In addition, in her judgment, the language used was too clinical and
appealed to a student diagnosed with some mental health disorder. The student suggested that we
should not use this kind of language so that the page would be more appealing to students with
problems or challenges, instead of sick students.
Results from the merging of these elements
We achieved the goal of getting the members of the academic community that we wanted to
impact to become actors in knowledge-building and to participate with us in the analysis of the
object of study (suicide among students and the stigma related to seeking help). They
participated in identifying the necessary elements to prevent and address suicide in students.
Similarly, they participated in the development and designing of a preventive campaign with
effective messages and images to be used in the academic setting taking into consideration our
particular cultural context.
Concretely, as a result of the Suicide Prevention Program the universitys Counseling Centers
visibility and presence in the campus increased, a webpage was developed and cases referred to

the Center were better documented. In addition, intervention protocols were developed and
distributed to the entire academic community.
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Conclusion
The development of a program for preventing a social phenomenon has to take into consideration
the particular characteristics of the cultural context in which the conduct shows up or is
manifested (Goldstein, Davis, Whitbeck, Murakami, Zayas, & Nagayama, 2008). Culture
influences the way in which mental sickness is perceived and the uneasiness a person might feel
when diagnosed as mentally sick. This is why we consider it important to acknowledge that
studying suicide is not complete if we limit ourselves to the information specialists have about
the topic. This is why it was important not to limit ourselves to receiving formal education on the
theorical aspects of suicide, but also to explore with the academic community their knowledge
about the topic. Such measures allowed us to explore conceptions, myths and, in general, the
social imaginaries about suicide, its definition and how to address it.
The intellectual product of science has an impact in societys material and symbolic life. So
exploring the ways stigma manifests itself was important for the SPP. The traditional view
individuals hold about mental health professionals addressing pathologies or individuals with
mental disorders can affect students decision of seeking help, as we found out in the discussion
groups we held with counselors and psychologists, students and other members of the academic
community.
We agree with Ratts cited in Greenleaf and Williams (2009) in that the approaches that place the
causes of problems on the individual and those focused on deficit and pathology can perpetuate
forms of social injustice and cultural oppression within counseling. We believe that sometimes,
symptoms are a product of the stress experienced by individuals with little power or living a
reality that is different from what they want (Fernndez, 2006).
Suicide is certainly an act that is committed individually most of the time, but when we look at it
in terms of process, it is a conceptual action. That is to say, it originates from the ideas derived
from the different norms and symbols that form culture and society. From this perspective,
suicide is a social act. It is not dictated as an inevitable destiny. Self-destructive behavior is often
accompanied by myths related to the values, beliefs and norms of the human groups. Social
researchers have the task of analyzing the construction of these myths about suicide, where
destiny and the inevitable play a central role. We should not forget that suicide can be prevented.
Research on the different issues associated with suicide contributes valuable elements to
understanding this behavior. When these elements are strategically disseminated, they become
important aspects of community prevention. This could be a good example of the social impact
that academic knowledge has in society. Understanding suicide through the lens of the academic
community reveals those aspects the community has to address. Suicide is a multi-factor
problem, where diverse social, cultural, psychological, educational and economic dynamics
converge. Being such a complex phenomenon, its study requires an interdisciplinary perspective
that allows for a broad understanding of self-destructive behavior at the personal and group level.
Studying and researching suicide requires multisector actions that have profound interactions
with the environment. In that sense, a program designed with this in mind will not only be
flexible, but will also be a space where components of the academic community interested in
research can converge.

We know that the collaborative strategy is useful in generating change and facilitates the
understanding of the area where we want to intervene. The Suicide Prevention Program of the
UPR-Cayey allowed us to develop a different methodology for doing things. Sometimes we
faced indifference, due particularly to the reductionist idea of seeing suicide as a problem that
only pertains to the individual in crisis, and not as a social problem. This individualistic view
hinders active participation in the process of reflection and discussion of alternatives that
contribute to the prevention and reduction of suicide rates.
In our prevention program, we had clear goals and objectives for suicide prevention. However,
we opened a space for the rest of the academic community to contribute on how to reach these
goals and objectives. The results obtained are the product of a dynamic process that values
human life and dignity, where members of every sector of the academic community participated
through discussion and action.
We want to share this experience not only to describe the development of a participative action
process, but also to emphasize its value and contribution to promoting hope and wellbeing
among our college students. We agree with Betancourt (2006), who also has a suicide prevention
program at a university setting:
And while statistics provide us with indifferent or detached numbers to which we are used to, as
if dead human beings were lost marbles, we know that every number has a face, a face that
looked at itself in other faces, maybe in yours, maybe in mine, and for that face, for that name,
we are working.
We consider suicide among students as a matter pertaining to everybody, because everybody can
do something about it.
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Acknowledgments
E1 SPP fue desarrollado en parte por el auspico de los fondos provistos por la subvencin
35H79SMO57822-03 de la Administracin de Servicios de Salud Mental y Abuso de Sustancias
(SAMHSA) del Departamento de Salud y Servicios Humanos Federal.
Las autoras agradecen a la doctoras Isar Godreau y Mariluz Franco y al profesor Jos Calderon
por sus recomendaciones al siguiente trabajo. Esta publicacin fue parcialmente apoyada por la
propuesta nmero P20 MD006144 del National Institute of Minority Health and Health
Disparities y su contenido es nicamente responsabilidad de sus autoras y no necesariamente
representa los criterios oficiales del Department of Health and Human Services; y la mencin de
marcas registradas, prcticas comerciales u or-ganizaciones no implica que sean respaldadas por
el Gobierno de los Estados Unidos.
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References
1. Adams J, Adams M. The association among negative life events, perceived problem
solving alternatives, depression, and suicidal ideation in adolescent psychiatric
patients. Journal of Child Psychology & Psychiatry & Allied
Disciplines. 1996;37(6):715720. [PubMed]

2. Appelbaum PS. Law & psychiatry: Depressed? get out!: Dealing with suicidal students
on college campuses. Psychiatric Services. 2006;57(7):914916. [PubMed]
3. Bentancurt LM. Prevencin del suicidio en estudiantes universitarios. Una perspectiva
psicosocial del fenmeno del suicidio: Los hijos de la desesperanza. Guanajuato
Gobierno del Estado: Observatorio de Ciencia, Tecnologa e Innovacin. 2006 Retrieved
fromhttp://octi.guanajuato.gob.mx/octigto/formularios/ideasConcyteg/Archivos/0804200
6_PREVENCION_SUICIDIO_ESTUDIANTES_UNIVERS.pdf.
4. Campos RM, Padilla S, Valerio JC. Prevencin de suicidio y conductas autodestructivas
en jvenes. Biblioteca Nacional de Salud y Seguridad Social
Costarricense. 2004 Retrieved fromhttp://www.binasss.sa.cr/adolescencia/aserril.pdf.
5. CEDE-UPR. Informe Estadstico del Centro de Consejera y Psicologa: AgostoMayo
20052009. Centro de Desarrollo Estudiantil de la Universidad de Puerto Rico en
Cayey. 2009
6. Durkheim E. Suicide. New York: Free Press; 1966.
7. Drum DJ, Brownson C, Denmark AB, Smith SE. New data on the nature of suicidal
crises in college students: Shifting the Paradigm. [Article] Professional Psychology
Research & Practice.2009;40(3):213222.
8. Fernndez M. Abordaje construccionista: Implicaciones para la prctica de la Consejera
y la Psicologa. Revista Profesional de la Asociacin Puertorriquea de Consejeria
Profesional.2006;19(1):812.
9. Gallagher RP. National survey of counseling center directors 2009. Washington, D.C.:
International Association of Counseling Services; 2009. Retrieved
from http://www.iacsinc.org/
10. Goldston DB, Molock SD, Whitbeck LB, Murakami JL, Zayas LH, Nagayama GC.
Cultural considerations in adolescent suicide prevention and psychosocial
treatment. American Psychologist.2008;63(1):1431. [PMC free article] [PubMed]
11. Greenleaf AT, Williams JM. Supporting social justice advocacy: A paradigm shift towards
an ecological perspective. [Article] Journal for Social Action in Counseling &
Psychology. 2009;2(1):114.
12. Instituto de Estadsitcas de Puerto Rico. Nuevas estadsticas de mortalidad, 200008. San
Juan: Puerto Rico; 2010. Retrieved from httpwww.estadisticas.gobierno.pr.
13. Jimenez M. Conducta e ideacin suicida en estudiantes universitarios. Griot. 2009;1:5
17.
14. Mateu MPS, Cuadra AR. E1 estigma en la salud mental: Un reto para el Siglo
XXI. Revista de Enfermera (Barcelona, Espaa) 2007;30(11):1618. 2124, 27
28. [PubMed]

15. Quinnett PG. Counseling Suicidal People: A Therapy of Hope. United States: The QPR
Institute Inc; 2000.
16. Reyes M, Surez A. Informe Oficial del Centro Universitario de Servicios
Psicolgicos. Puerto Rico: Departamento de Psicologa, Universidad de Puerto Rico;
2006. Prevalencia de Trastornos Alimentarios y Depresin en Estudiantes de Nuevo
Ingreso en el Sistema de la Universidad de Puerto Rico para los aos 20042006.
17. Rojas R. Investigacin-accin en el aula. 1 ed. Espaa: Plaza y Valds; 1995.
18. Rossell J, Berros M. Ideacin suicida, depresin, actitudes disfuncionales, eventos de
vida estresantes y autoestima en una muestra de adolescentes puertorriqueos/as. Revista
Interamericana de Psicologa/Interamerican Journal of Psychology. 2004;38(2):295302.
19. Silenzio VB, Pena JB, Duberstein PR, Cerel J, Knox KL. Sexual orientation and risk
factors for suicidal ideation and suicide attempts among adolescents and young
adults. American Journal of Public Health. 2007;97(11):20172019. [PMC free
article] [PubMed]
20. Tendenciaspr. Compendio de estadsticas: Violencia en Puerto Rico, 2009. Proyecto
Tendenciaspr.2010 Retrieved from www.tendenciaspr.com.
21. Varas N, Cintron F. Estigma y salud en Puerto Rico: consecuencias detrimentales de lo
alterno. San Juan, Puerto Rico: Publicaciones Puertorriqueas; 2007.
22. WHO. World Suicide Prevention Day. World Health Organization, Media
Centre. 2011 From
fromhttp://www.who.int/mediacentre/events/annual/world_suicide_prevention_day/en/in
dex.html.
23. Wilcox HC, Arria AM, Caldeira KM, Vincent KB, Pinchevsky GM, OGrady KE.
Prevalence and predictors of persistent suicide ideation, plans, and attempts during
college. Journal of Affective Disorders. 2010;127(13):287294. [PMC free
article] [PubMed]

ARTICLE 2

Abstract
Suicide, or the act of deliberately ending ones own life, is considered a public health problem.
The statitiscs shows that an average of 3,000 individuals commits suicide daily. For each
effective occurrence, 20 or more individuals attempt it (World Health Organization. 2011).
According to the Centers for Disease Control and Prevention, suicide is the third cause of death
in the United States among individuals between 15 and 24 years, as cited by Appelbaum (2006).
In Puerto Rico, according to statistics offered by the Heath Department, in 2008 there were 299
suicides, which represent a rate of 7.5 for every 100,000 Puerto Ricans. (Instituto de Estadsticas
de PR, 2010)
Every year in the United States, approximately 1,100 college students between the ages of 18
and 24 commit suicide, and nearly 24,000 attempt it (Appelbaum, 2006). A four-year prospective
study done in the United States with freshman college students revealed that 12% had suicidal
ideation sometime during their years at college (Wilcox, Arria, Caldeira, et al., 2010).
Since the 80s, counseling center directors in the United States have been participating in an
ongoing survey every two years. The survey is sponsored by the Association for University and
College Counseling Center Directors. Since 2005, data from this survey reveals an increase of
students that exhibit severe mental health problems and seek help through the counseling centers
(Gallager, 2009).
Similarly, literature on the issue in Puerto Rico indicates that suicidal ideation and suicidal
behavior are more frequently detected in students that seek help through the university
counseling centers (Jimnez, 2009).
On the occurrence of behaviors associated with suicide, there are some studies that indicate that
one out of every five suicides among college students occur the same day they are having a life

crisis (Appelbaum, 2006). This finding points to the importance of not only investigating more
deeply every aspect of the various behaviors associated with suicide, but also the way in which
individuals think about this phenomenon.
Although suicide is an extremely important topic, its discussion in Puerto Rican society is very
limited, particularly when it has to do with suicide among young persons. Campos, Padilla, and
Valerio (2004)indicate that this is because individuals avoid and prefer not to face the fact that
some young individuals think life is that painful and are killing themselves in a conscious and
deliberate manner. This fact has an impact on and partially questions our social and family
system.
Although research on mental health and behaviors associated with suicide among college
students is scarce in Puerto Rico when compared to what has been published in the United
States, a study done with the students of the University of Puerto Rico (UPR) indicated that
15.4% of surveyed students reported depressive symptomatology on a self-assessment scale
(Reyes & Surez, 2006). On the other hand, statistics from 2005 to 2009 at the Interdisciplinary
Center for Student Development at the UPR-Cayey Campus (CEDE, for its acronym in Spanish)
indicate that depressive symptoms were the most frequent problem among students serviced at
the center through individual counseling.
Mental health research suggests the need to work on suicide prevention and intervention at
universities, so that strategies can be developed to prevent suicide, fight against the stigma of
seeking help, and promote wellbeing among college students. However, at the University of
Puerto Rico (UPR) no systematic activities were in place to prevent suicide outside the clinical
and therapeutic setting. This changed since 2006, when the Substance Abuse and Mental Health
Services Administration (SAMHSA) awarded a grant to the UPR-Cayey Campus to develop a
program on suicide prevention in the university context. Another 29 universities in the United
States and a private university in Puerto Rico also received the SAMHSA grant to develop this
type of program.
This paper presents and discusses the process of developing and implementing the Suicide
Prevention Program among college students (SPP) that was developed at the University of
Puerto Rico- Cayey Campus (UPR-Cayey) as a result of the collaboration with SAMHSA. The
model we developed is collaborative in nature, which means that the aspect of prevention
involves every sector of the university. As part of the experience, we implemented two key
strategies to develop a successful collaborative model in the university setting: 1) Ask every
sector to participate as advisors/collaborators in the development of prevention strategies; and 2)
use culturally appropriate language to minimize the stigma associated with mental health
problems. Below we will describe these strategies and the importance of using culturally
sensitive models for suicide prevention among college students.
Go to:

Development of the Suicide Prevention Program (SPP)

The Suicide Prevention Program (SPP) implemented at the UPR-Cayey was the first federally
funded initiative in the University of Puerto Rico system to address this problem. The UPRCayey is a public liberal arts institution that grants undergraduate degrees. It is located in the
central part of the island of Puerto Rico and has approximately 3,300 students enrolled. It is also
part of a system composed of eleven campuses with approximately 59,000 students.

Goals and Objectives of the SPP

At the campus, the main goals with the SPP were the development of a campaign directed at
providing information and increasing awareness in the academic community about suicide and
its prevention. In addition, our intention was to reduce the stigma associated with seeking help
for mental health services. Our objectives were: a) to develop an emergency management and
response plan; b) to prepare educational material; and c) to create a webpage about who could
seek help, and when, where and how to seek it. During the Programs planning and
implementation process, it was important to start thinking about the particularities of our
universitys students, faculty and staff, and our universitys culture. Various lessons and
successful practices, which can be useful to other programs, were the product of this process of
reflection. Following we present the process which led to the development of the SPP.
Initial Phase: Coordinate and offer training about the topic to students, faculty
and staff
The first step in developing the campaign was to coordinate training sessions offered by local
experts on the topic of suicide. These conferences were directed at mental health professionals
working at the counseling centers (counselors and psychologists) from the eleven campuses of
the UPR system. These trainings were extremely valuable for the eventual planning of
prevention activities at the UPR-Cayey Campus.
During these meetings, we gathered information about everyones daily experiences working at
the counseling centers. For example, we explored experiences related to intervention with
students with mental health issues. Meeting participants also shared their experiences and
interventions with suicidal crises. One important aspect identified was the fact that none of the
centers had developed a crisis protocol, which was necessary. Another aspect was the importance
of integrating every component of the academic community in the prevention of suicide. To
accomplish this we needed to develop strategies because the main problem was that the academic
community was not involved and only relied on professionals at the counseling center for suicide
prevention. We were interested in learning how other colleague counselors in the UPR system
perceived the role of other community members (faculty, staff, students) in promoting wellness
and prevention.
It became quickly evident that we were confronting similar situations. For example, students
participation in workshops was scarce. Typically, students do not attend activities that are not
related to their courses, or their attendance is very limited. We needed to develop strategies that
would stimulate student participation in the different activities.
Another common experience was the challenge of getting professors to refer students to the
counseling centers. We knew that professors were probably the first ones to notice in students the
need to receive counseling and that it was important for them to participate in our discussions.
However, given their multiple and complex responsibilities, colleagues informed that getting
them to coincide for a meeting or training was very difficult.
In addition to receiving training and sharing with other colleagues during this initial phase of the
project, we also reviewed various training models available through the internet and aimed at lay
persons on how to educate about suicide prevention. We chose the Question, Persuade and Refer
model (QPR). This strategy was chosen because it is recognized as an evidence-based practice
(Quinet, 2000). We would also be able to get a certification on the intervention by completing
modules and taking online courses, and without having to travel outside the country. In addition,

the reasonable cost of being trained as instructors would allow us to train and certify an
unlimited amount of gatekeepers and it included various materials and books for us and for the
gatekeepers. Another advantage was that the gatekeepers training could be offered with a certain
amount of flexibility, making it culturally appropriate and completely adjustable to our
population and to the availability of our participants.
Second Phase: Develop the Question, Persuade and Refer (QPR) Training
The QPR is based on the premise that talking about death at a personal and group level allows
individuals to get more awareness of the signs that a persons woh is thinking about suicide shows
and where to refer for help. (Quinnett, 2000). Using this model as a foundation, our team
designed and adapted a one-and-a-half-hour workshop, which offers general information about
the prevalence of suicidal behavior in our students and discusses some myths about the topic. We
adapted the training according to participants time availability, but always including the key
elements: talk and ask questions to the person at risk for suicide, persuade them to seek help and,
if needed, refer the person to professional help.
The emphasis of this workshop was on the importance of having the participation of the entire
academic community in suicide prevention among college students. The student in need decides
who he talks to about this (for example, it could be another student, a professor, or a staff
person). This is why it was so important to train the entire academic community. When designing
the workshop for professors, for example, we emphasized the fact that, in addition to the idea of
dying, there could be indicators of anguish and hopelessness. Another objective for the
professors training was to share information about how to identifify students who might be
considering the idea of taking their lives. We also presented and modeled strategies to persuade
an individual to seek help and offered information about referral resources.
Once the QPR workshop was adapted, the team was challenged with the task of implementing it
to train every sector of the academic community.
Go to:

Strategies to Educate and Disseminate Information About the Issue

We identify two key elements to educate and disseminate information about the important facts
about suicide and about actions that can be taken in those cases. The first key element is to
recruit every part of the academi community to become consultants. The second key elemnt is to
use culturally adequate language to reduce the impact of stigma on students. In the next section
we elaborate about these elements.
Key Element #1: To Recruit Every Part of the Academic Community to Become
Consultants
Talking about students mental health is typically seen as a matter pertaining exclusively to the
counseling centers and we wanted to initiate a dialogue about this topic with every sector. To
increase participation, we had to come up with diverse alternatives.
Counselors and Psychologists
One of the most significant contributions of this experience was to include this group as
consultants and collaborators. Although we work for the same system, as a professional group we

have very limited opportunities to meet and share our experiences working in an academic
context. Response from this group was excellent, 95% of those invited came to the meeting.
The participation of the counselors and psychologists who work at the UPR-Cayey was a key
element to this project. We were the first ones to meet and participate in formal training on the
topic, including the certification as QPR instructors. The Program covered the cost of the
certification. It also paid stipends so that the staff could participate in meetings for brainstorming
and strategy development in the areas we wanted to develop to address the issue of suicidal
behavior. First, the need to promote services and the process of referral and intervention in atrisk cases was identified as an area to improve. As a product of these meetings, this group of
colleagues came up with a slogan to promote the Counseling Center (CEDE) within the
academic community. This slogan had to be attractive for students, which are our clientele. The
slogan was: Your challenges are not only academic. When it gets tough, let us help you. It was
included in posters and the CEDE promotional materials and this is how the CEDE promotional
campaign started. The staff also collaborated in developing the intervention protocol for
individuals at risk of suicide and the initial screening of referred students. In addition, the Center
started a registry of the suicide risk cases addressed. The experience of pairing the Centers goals
with the goals of the Suicide Prevention Program was a key element in establishing practices that
are still being implemented even after federal funding has ended. The fact that the promotional
strategies and the intervention protocols were a product of the group working at the CEDE and
were not adopted from an external entity contributed to their rapid implementation at the CEDE
and contributed to the dissemination and permanence of the campaign at the university.
Students
We met with the presidents of every student organization and asked for their collaboration in
getting the students to participate in the SPP. We did this because we knew that it was easier for a
student to talk about his/her worries with another student than with an adult, even if it is a mental
health specialist. We decided to train every member of the student organizations free of charge to
become collaborators or gatekeepers in suicide prevention. These students took the training and
obtained a certification as gatekeepers. Their role was to collaborate with the program in
detecting signs of suicidal risk in other students and knowing how to persuade them to seek help
and refer them. When presenting this proposal to them, we emphasized their abilities and
leadership skills. In addition, we asked them for ideas to develop strategies for suicide prevention
in addition to the ones presented during the training or before receiving the training. We made
emphasis on the fact that, as peers, they could be key elements in identifying at-risk students.
As a result, some student organizations developed activities in which they combined preventive
action with academic content. For example, a student from the undergraduate math program
decided to write a paper for her Statistics course where she explained various concepts using
suicidal behavior rates by age and gender and compared them by geographical region. These
groups also had the idea of holding a suicide prevention day. One of the activities during the day
was that students asked their professor to use 5 minutes in class to read facts about the topic of
suicide and promote among students the use of counseling services when they had difficult
challenges to deal with. Another student organization prepared a mural with the slogan Laugh,
Live and Love, to promote among students expressions of their reasons to be alive. Through
these and other strategies, we had an impact on 90% of the students participating in student
organizations.
Staff

Coordinating staff assistance for the training sessions was one of the most successful. It was
coordinated for security officers and secretaries. In both cases, we presented them with the
possibility of a workshop and emphasized on how their role as part of the academic community
allowed them to identify special situations among students early on. We think that the emphasis
we made on their vantage point for detecting and referring contributed to a greater participation
in the workshops. Security officers explained that because they are always present on campus,
they observe students in their daily interactions and can identify mood states, sometimes way
before counseling professionals who are in their offices. In addition, secretaries pointed out that
because they have daily contact with many students who come to ask questions and seek help
with academic issues, sometimes they got students who talked with them about daily worries and
problems. Both security officers and secretaries felt that their role allowed them to identify and
refer students that needed additional help. The Human Resources office included the topic of
suicide prevention among the topics offered periodically to employees for professional
development.
Another group that was included as consultant and that was especially productive was the
Graphic Arts division and its personnel. This division was a key player in designing the local
campaigns creative concept. One of the suggestions they made was to develop posters with short
messages, complemented with images or photos. They also contributed by using individuals
from the academic community as models, which attracted attention towards the posters and, of
course, towards the campaign.
Teaching personnel
With the professors, we were successful in getting some time during a faculty meeting, where we
indicated that we wanted to get their opinions and recommendations about the strategies we had
developed in the prevention campaign. We were not able to get a time allocated for offering a
workshop or training. It was extremely useful to get professors involved as consultants, given
their experience with students and their particular competencies. This strategy increased interest
in the issue of suicidal conduct. Professors contribution to the process was to approve the
strategies we were using. The opportunity of talking with professors about our interest in suicide
prevention and letting them know that everyone in the academic community could contribute
was aimed at stimulating them to collaborate in identifying students who could be at-risk and
refer them or guide them to seek help. We started to receive referrals from professors and we
even had professors who personally brought students to the Center.
The dialogues with the various sectors of the academic community helped discover ways in
which everyone could contribute, participate or generate strategies for suicide prevention.
Counselors contributed their experience and a strategy to promote the Counseling Centers
services was developed with them. The strategy included a slogan for the Counseling Center, a
web page and an emergency protocol. The slogan and the promotional messages were developed
taking into account suggestions students had given, including to use messages related to stress
generating situations in academic life and to avoid pathologizing jargon. Our campaign was
characterized by using culturally appropriate language for college students. When we talked
about this with professors and staff, they indicated that given the type of scenarios in which they
offer their services, this would facilitate interaction with the students and help detect indicators
that a student might need help. In the next section, we will explain these consultation processes
in detail.
Findings of the Consultation Process

Discussion groups held with colleague counselors and students took place at the University. We
invited counselors to come to a meeting that was held in a non-working day with the purpose of
brainstorming to produce strategies for suicide prevention. We provided a stipend for
participating. With students, we coordinated meetings with theater students and with the leaders
of the student organizations to present the Suicide Prevention Program and ask for ideas on how
they thought the campaign could be more effective. In both cases, an open question format was
used. The questions were designed to explore the main problems affecting students wellbeing.
These discussion groups developed from the Project Directors interest in working in a
collaborative manner and developing culturally appropriate and relevant products.
A very interesting aspect of these dialogues was that participants perceived the university as a
scenario that stimulates competence and goal attainment, which consciously or unconsciously
inhibits people from showing their vulnerabilities. Students informed that this culture of
competition could generate excessive stress and anxiety. Our University has high admission
standards. For this reason, some students find it difficult to let others see them as vulnerable or
incapable of meeting academic demands. In addition, there was consensus among participating
academic community members on the fact that in Puerto Rico there is prejudice against persons
who visit a mental health professional.
Some students reported being preoccupied with being identified as a mentally sick person as a
result of visiting a mental health professional. Studies indicate that mental health has a stigma in
society (Mateu & Cuadra, 2007). In Puerto Rico there has also been some research done on the
stigma associated with prejudice against individuals who visit a psychologist or other mental
health professionals (Varas & Cintrn, 2007). For us it was evident, particularly when exploring
students perspective, that we needed to overcome the clinical paradigm of suicide prevention as
an individual matter that only pertains the individual with suicidal behavior and in which only
the mental health professional intervenes.
From our experience at the CEDE and from the dialogues held with other colleagues, we knew
that the general attitude in the academic community was to delegate suicide prevention and
intervention exclusively to the Universitys mental health professionals. In order to recruit every
sector of the academic community, this perception had to be changed. In addition, a collaborative
approach that included every member of the academic community in the efforts made to prevent
suicide had to be implemented. That is to say, far from assuming the clinical construction of what
mental health problems are, we wanted to examine which were the typical problems that students
faced and if their lack of skills to manage them could increase the risk of suicidal behavior.
During group discussion with students, we explored the typical problems and life events that can
affect their performance and sense of wellbeing, driving them to consider suicidal behavior. They
informed various difficult events that can generate distress in college students, such as: (a)
romantic breakups; (b) rejection because of sexual orientation; (c) problems at home; (d) stress
related to studying and working at the same time; (e) being a parent; and (f) depressed mood. We
validated this knowledge, which was based on their experiences. This was particularly relevant
because there is local and international research that supports the relationship between suicidal
ideation and negative life events (Adams & Adams, 1996; Rosello & Berrios, 2004;). There is
research that identifies romantic breakups as the most important cause of suicidal behavior in
young persons (Drum, Brownson, Burton, & Smith, 2009). Similarly, research on the topic
indicates that difficulties related to feeling discriminated or rejected due to sexual orientation can
also be a risk factor for suicide (Silenzio, Pena, Duberstein, Cerel, & Knox, 2007).

The dialogues and collaborative experiences with the various groups of collaborators from the
academic community were extremely productive in generating ideas and strategies, mainly
because they helped us to broaden our information with a cultural perspective. That is to say, if
our program was aimed at young college students at the undergraduate level, most of them raised
in the central part of the Island, it was important to try to know and understand their
particularities. Similarly, we wanted to understand their worldview and to see how it differed
from our own. This was especially important because we are professional adults and come from
a different cultural group. We recommend that the visual materials take into consideration
culturally relevant symbols and metaphors, actors and models.
Key Element #2: Use Culturally Adequate Language to Reduce the Impact of
Stigma on Students
Following we present some of the ways we implemented the findings obtained through
discussion groups, workshops and dialogues.
Slogan
We decided that the Suicide Prevention Program campaign should use non-biased language that
did not contribute to stigma-generating conceptions. This required us to focus on difficulties
inherent to the academic experience and the developmental stage where most part of the students
were, as well as on the challenges they must deal with. Taking this into account, one of the first
actions that this strategy generated was the development of a slogan to promote among students
the practice of seeking help. The slogan selected was: Your challenges are not only academic.
When it gets tough, let us help you. This slogan was culturally appropriate and did not use
pathologizing or stigma-generating language. This was achieved by framing students problems
as challenges; which empowers the student. This slogan states that academic life is much more
than acquiring academic competences or skills. It is a time in life in which the individual is also
facing other personal, economic, family and relational matters, which can produce stress and are
potentially dangerous for the persons stability and wellbeing. In this slogan, we invite the person
to visit the mental health specialists at the Counseling Center, which emphasizes help and
support instead of diagnosis and treatment of a particular condition.
Posters
With the information we had about the typical problems students face, we prepared posters
representing the situations described by them. The models used for the posters were students,
employees and a professor from our University.
One of the contributions of the collaborative approach to the development of the prevention
campaign was the language used to name the typical problems students face, without using
traditional DSM IV categories. For example, in one of the posters, the image of a visibly sad
young man is accompanied by the word rocheao. In English, the meaning of this word would
be similar to that of bummed out. Young people use this word to describe a sad or anguished
emotional state. This type of word is common among young Puerto Ricans language. Including
this word intended to connect with them. On the other hand, including members of the academic
community in the posters resulted in a very effective element for bringing attention to the posters
and to the message.
Webpage

Students perspective on the topic also contributed to the development of a webpage for the
Counseling Center (which was part of the objectives of the PPS). During the process of
designing the webpage, a very talented freshman reviewed the pages of prevention programs in
other universities. As a result, she decided that in building our page she should focus on the
challenges students face and not on the deficits. According to this student, in her review, she
found that some pages included instruments to screen for depression, panic attacks and eating
disorders, among others. In addition, in her judgment, the language used was too clinical and
appealed to a student diagnosed with some mental health disorder. The student suggested that we
should not use this kind of language so that the page would be more appealing to students with
problems or challenges, instead of sick students.
Results from the merging of these elements
We achieved the goal of getting the members of the academic community that we wanted to
impact to become actors in knowledge-building and to participate with us in the analysis of the
object of study (suicide among students and the stigma related to seeking help). They
participated in identifying the necessary elements to prevent and address suicide in students.
Similarly, they participated in the development and designing of a preventive campaign with
effective messages and images to be used in the academic setting taking into consideration our
particular cultural context.
Concretely, as a result of the Suicide Prevention Program the universitys Counseling Centers
visibility and presence in the campus increased, a webpage was developed and cases referred to
the Center were better documented. In addition, intervention protocols were developed and
distributed to the entire academic community.
Go to:

Conclusion
The development of a program for preventing a social phenomenon has to take into consideration
the particular characteristics of the cultural context in which the conduct shows up or is
manifested (Goldstein, Davis, Whitbeck, Murakami, Zayas, & Nagayama, 2008). Culture
influences the way in which mental sickness is perceived and the uneasiness a person might feel
when diagnosed as mentally sick. This is why we consider it important to acknowledge that
studying suicide is not complete if we limit ourselves to the information specialists have about
the topic. This is why it was important not to limit ourselves to receiving formal education on the
theorical aspects of suicide, but also to explore with the academic community their knowledge
about the topic. Such measures allowed us to explore conceptions, myths and, in general, the
social imaginaries about suicide, its definition and how to address it.
The intellectual product of science has an impact in societys material and symbolic life. So
exploring the ways stigma manifests itself was important for the SPP. The traditional view
individuals hold about mental health professionals addressing pathologies or individuals with
mental disorders can affect students decision of seeking help, as we found out in the discussion
groups we held with counselors and psychologists, students and other members of the academic
community.
We agree with Ratts cited in Greenleaf and Williams (2009) in that the approaches that place the
causes of problems on the individual and those focused on deficit and pathology can perpetuate
forms of social injustice and cultural oppression within counseling. We believe that sometimes,

symptoms are a product of the stress experienced by individuals with little power or living a
reality that is different from what they want (Fernndez, 2006).
Suicide is certainly an act that is committed individually most of the time, but when we look at it
in terms of process, it is a conceptual action. That is to say, it originates from the ideas derived
from the different norms and symbols that form culture and society. From this perspective,
suicide is a social act. It is not dictated as an inevitable destiny. Self-destructive behavior is often
accompanied by myths related to the values, beliefs and norms of the human groups. Social
researchers have the task of analyzing the construction of these myths about suicide, where
destiny and the inevitable play a central role. We should not forget that suicide can be prevented.
Research on the different issues associated with suicide contributes valuable elements to
understanding this behavior. When these elements are strategically disseminated, they become
important aspects of community prevention. This could be a good example of the social impact
that academic knowledge has in society. Understanding suicide through the lens of the academic
community reveals those aspects the community has to address. Suicide is a multi-factor
problem, where diverse social, cultural, psychological, educational and economic dynamics
converge. Being such a complex phenomenon, its study requires an interdisciplinary perspective
that allows for a broad understanding of self-destructive behavior at the personal and group level.
Studying and researching suicide requires multisector actions that have profound interactions
with the environment. In that sense, a program designed with this in mind will not only be
flexible, but will also be a space where components of the academic community interested in
research can converge.
We know that the collaborative strategy is useful in generating change and facilitates the
understanding of the area where we want to intervene. The Suicide Prevention Program of the
UPR-Cayey allowed us to develop a different methodology for doing things. Sometimes we
faced indifference, due particularly to the reductionist idea of seeing suicide as a problem that
only pertains to the individual in crisis, and not as a social problem. This individualistic view
hinders active participation in the process of reflection and discussion of alternatives that
contribute to the prevention and reduction of suicide rates.
In our prevention program, we had clear goals and objectives for suicide prevention. However,
we opened a space for the rest of the academic community to contribute on how to reach these
goals and objectives. The results obtained are the product of a dynamic process that values
human life and dignity, where members of every sector of the academic community participated
through discussion and action.
We want to share this experience not only to describe the development of a participative action
process, but also to emphasize its value and contribution to promoting hope and wellbeing
among our college students. We agree with Betancourt (2006), who also has a suicide prevention
program at a university setting:
And while statistics provide us with indifferent or detached numbers to which we are used to, as
if dead human beings were lost marbles, we know that every number has a face, a face that
looked at itself in other faces, maybe in yours, maybe in mine, and for that face, for that name,
we are working.
We consider suicide among students as a matter pertaining to everybody, because everybody can
do something about it.
Go to:

Acknowledgments
E1 SPP fue desarrollado en parte por el auspico de los fondos provistos por la subvencin
35H79SMO57822-03 de la Administracin de Servicios de Salud Mental y Abuso de Sustancias
(SAMHSA) del Departamento de Salud y Servicios Humanos Federal.
Las autoras agradecen a la doctoras Isar Godreau y Mariluz Franco y al profesor Jos Calderon
por sus recomendaciones al siguiente trabajo. Esta publicacin fue parcialmente apoyada por la
propuesta nmero P20 MD006144 del National Institute of Minority Health and Health
Disparities y su contenido es nicamente responsabilidad de sus autoras y no necesariamente
representa los criterios oficiales del Department of Health and Human Services; y la mencin de
marcas registradas, prcticas comerciales u or-ganizaciones no implica que sean respaldadas por
el Gobierno de los Estados Unidos.
Go to:

References
1. Adams J, Adams M. The association among negative life events, perceived problem
solving alternatives, depression, and suicidal ideation in adolescent psychiatric
patients. Journal of Child Psychology & Psychiatry & Allied
Disciplines. 1996;37(6):715720. [PubMed]
2. Appelbaum PS. Law & psychiatry: Depressed? get out!: Dealing with suicidal students
on college campuses. Psychiatric Services. 2006;57(7):914916. [PubMed]
3. Bentancurt LM. Prevencin del suicidio en estudiantes universitarios. Una perspectiva
psicosocial del fenmeno del suicidio: Los hijos de la desesperanza. Guanajuato
Gobierno del Estado: Observatorio de Ciencia, Tecnologa e Innovacin. 2006 Retrieved
fromhttp://octi.guanajuato.gob.mx/octigto/formularios/ideasConcyteg/Archivos/0804200
6_PREVENCION_SUICIDIO_ESTUDIANTES_UNIVERS.pdf.
4. Campos RM, Padilla S, Valerio JC. Prevencin de suicidio y conductas autodestructivas
en jvenes. Biblioteca Nacional de Salud y Seguridad Social
Costarricense. 2004 Retrieved fromhttp://www.binasss.sa.cr/adolescencia/aserril.pdf.
5. CEDE-UPR. Informe Estadstico del Centro de Consejera y Psicologa: AgostoMayo
20052009. Centro de Desarrollo Estudiantil de la Universidad de Puerto Rico en
Cayey. 2009
6. Durkheim E. Suicide. New York: Free Press; 1966.
7. Drum DJ, Brownson C, Denmark AB, Smith SE. New data on the nature of suicidal
crises in college students: Shifting the Paradigm. [Article] Professional Psychology
Research & Practice.2009;40(3):213222.
8. Fernndez M. Abordaje construccionista: Implicaciones para la prctica de la Consejera
y la Psicologa. Revista Profesional de la Asociacin Puertorriquea de Consejeria
Profesional.2006;19(1):812.

9. Gallagher RP. National survey of counseling center directors 2009. Washington, D.C.:
International Association of Counseling Services; 2009. Retrieved
from http://www.iacsinc.org/
10. Goldston DB, Molock SD, Whitbeck LB, Murakami JL, Zayas LH, Nagayama GC.
Cultural considerations in adolescent suicide prevention and psychosocial
treatment. American Psychologist.2008;63(1):1431. [PMC free article] [PubMed]
11. Greenleaf AT, Williams JM. Supporting social justice advocacy: A paradigm shift towards
an ecological perspective. [Article] Journal for Social Action in Counseling &
Psychology. 2009;2(1):114.
12. Instituto de Estadsitcas de Puerto Rico. Nuevas estadsticas de mortalidad, 200008. San
Juan: Puerto Rico; 2010. Retrieved from httpwww.estadisticas.gobierno.pr.
13. Jimenez M. Conducta e ideacin suicida en estudiantes universitarios. Griot. 2009;1:5
17.
14. Mateu MPS, Cuadra AR. E1 estigma en la salud mental: Un reto para el Siglo
XXI. Revista de Enfermera (Barcelona, Espaa) 2007;30(11):1618. 2124, 27
28. [PubMed]
15. Quinnett PG. Counseling Suicidal People: A Therapy of Hope. United States: The QPR
Institute Inc; 2000.
16. Reyes M, Surez A. Informe Oficial del Centro Universitario de Servicios
Psicolgicos. Puerto Rico: Departamento de Psicologa, Universidad de Puerto Rico;
2006. Prevalencia de Trastornos Alimentarios y Depresin en Estudiantes de Nuevo
Ingreso en el Sistema de la Universidad de Puerto Rico para los aos 20042006.
17. Rojas R. Investigacin-accin en el aula. 1 ed. Espaa: Plaza y Valds; 1995.
18. Rossell J, Berros M. Ideacin suicida, depresin, actitudes disfuncionales, eventos de
vida estresantes y autoestima en una muestra de adolescentes puertorriqueos/as. Revista
Interamericana de Psicologa/Interamerican Journal of Psychology. 2004;38(2):295302.
19. Silenzio VB, Pena JB, Duberstein PR, Cerel J, Knox KL. Sexual orientation and risk
factors for suicidal ideation and suicide attempts among adolescents and young
adults. American Journal of Public Health. 2007;97(11):20172019. [PMC free
article] [PubMed]
20. Tendenciaspr. Compendio de estadsticas: Violencia en Puerto Rico, 2009. Proyecto
Tendenciaspr.2010 Retrieved from www.tendenciaspr.com.
21. Varas N, Cintron F. Estigma y salud en Puerto Rico: consecuencias detrimentales de lo
alterno. San Juan, Puerto Rico: Publicaciones Puertorriqueas; 2007.
22. WHO. World Suicide Prevention Day. World Health Organization, Media
Centre. 2011 From

fromhttp://www.who.int/mediacentre/events/annual/world_suicide_prevention_day/en/in
dex.html.
23. Wilcox HC, Arria AM, Caldeira KM, Vincent KB, Pinchevsky GM, OGrady KE.
Prevalence and predictors of persistent suicide ideation, plans, and attempts during
college. Journal of Affective Disorders. 2010;127(13):287294. [PMC free
article] [PubMed]

Article 3
MARQUETTE LAW REVIEW Volume 91 Spring 2008 Number 3 SUICIDE ON
CAMPUS: THE APPROPRIATE LEGAL RESPONSIBILITY OF COLLEGE PERSONNEL
ANN MACLEAN MASSIE* TABLE OF CONTENTS I. INTRO D U CTIO
N ........................................................................... 627 II. SCOPE AND NATURE
OF THE PROBLEM .................................. 632 III. THE CASE FOR LIABILITY:
TORT LAW .................................... 637 A. Restatement (Second) Section 314A
and Restatement (Third) Section 40: "Special Relationships" .. 637 B. FERPA:
Not a Valid Defense Now ................................. 646 C. ... But the Proposed
Amendment Would Offer Valuable
Clarification ........................................................... 651 IV. THE ARGUMENT
FROM PSYCHOLOGY ..................................... 653 A. Mental Health Issues on

Campus ......................................... 654 B. Brain Development Studies: A New

Avenue to B ehavioral R esearch ................................................................ 659
V. THE ARGUMENT FROM MORALITY .......................................... 665 *
Professor of Law, Washington and Lee University School of Law; M.T.S., 2005,
Candler School of Theology, Emory University; J.D., 1971, University of
Virginia; B.A., 1966, Duke University. The assistance of the Frances Lewis Law
Center, Washington and Lee University School of Law, is gratefully
acknowledged. I would also like to thank my very able research assistants,
Michael McCarthy, Brian Reddan, Erick Carlson, and Brian Wilberg, without
whose help this project would not have come to fruition. Thanks also to
Randall P. Bezanson, David H. Vernon Professor of Law, University of Iowa
College of Law, and former Dean of Washington and Lee School of Law, for
reading an earlier version of this manuscript. MARQUETTE LAW REVIEW VI.
OBJECTIONS TO A RULE OF POTENTIAL NON-CLINICIAN L IA B
ILITY ..................................................................................... 668 A . L egal A
rgum ents .................................................................... 669 1. "Special
Relationship" Criteria Are Lacking ................ 669 2. The Double-Bind: Liable
Whatever the Institution D o
es? ............................................. ..................................... 670 B . Policy A
rgum ents ................................................................... 674 1. The Danger of
"Perverse Incentives" on Both Sides .... 674 2. Non-Clinician Administrators
Lack the Expertise to Make These Judgment Calls ............................................
675 VII. THE PROPOSED RULE OF LAW ................................................. 679
VIII. APPLICATION OF THE PRINCIPLE TO CASES ........................... 683 IX . C
ON CLU SIO N ................................................................................ 686
Author's note: The recent tragic events at Virginia Tech and Northern Illinois
University' have triggered a new round of discussion about students with
mental health problems on campus and how colleges and universities either
may or should respond to the recurring issues raised by the presence of such
students. 2 While the violence wreaked by Seung-Hui Cho on April 16, 2007,
and Stephen P. Kazmierczak on February 14, 2008, could doubtlessly not have
been predicted, there are vocal forces declaring that institutions of higher
learning should have the power to notify parents when a student appears to
campus personnel to pose a real danger to self or others. The question
typically arises when a student presents an imminent danger of self-harm.3
This Article deals with that 1. See, e.g., John M. Broder, 32 Shot Dead in
Virginia; Worst U.S. Gun Rampage, N.Y. TIMES, Apr. 17, 2007, at Al; Jeff Coen
& Monique Garcia, Police Piecing Together Gunman's Activities, Still Lack
Motive, CHI. TRIB., Feb. 16, 2008, at C19. 2. See, e.g., Eleanor Chute,
Colleges to Discuss How to Help Mentally Ill Students, PITT. POST-GAZETTE,
Apr. 23, 2007, at Al; Tamar Lewin, Laws Limit Colleges' Options When a
Student Is Mentally Ill, N.Y. TIMES, Apr. 19, 2007, at Al; Editorial, Parents' Right
to Know, STAR-LEDGER (Newark, N.J.), Apr. 19, 2007, at 18; Chuck Plunkett,
Colleges' Policies Matter of Life, Death: The Legal and Moral Paths Are
Anything but Clear When Balancing Concerns of Safety, Privacy and Mental
Health, DENV. POST, Apr. 22, 2007, at A-l; Michael P. Riccards, Colleges
Confront Privacy Laws in Handling Troubled Students, ASBURY PARK PRESS
(Neptune, N.J.), May 15, 2007, at Opinion; Editorial, A Shooter's Signals: When
Is a Warning Sign a Threat?, WASH. POST, Apr. 19, 2007, at A26; Stephen Joel
Trachtenberg, Op-Ed., Our Worst Nightmare, WASH. POST, Apr. 19, 2007, at
A27; Alisa Ulferts, What More Can Be Done?, ST. PETERSBURG TIMES (St.
Petersburg, Fla.), Apr. 22, 2007, at 1A. 3. See, e.g., Andrea Jones, Counseling
a Fine Line for Colleges: Schools Such as Emory Face Red Tape, Legal

Landmines When Trying to Help Students Suffering from Mental Illness,

ATLANTA J.-CONST., Apr. 22, 2007, at 1A; Susan Kinzie, Colleges Feel Caught
in Shifting [91:625 SUICIDE ON CAMPUS topic and proposes a rule of law that
would impose a duty on college and university administrators (including
faculty) to take reasonable steps to protect a student from self-harm when
the administrator has actual knowledge that the student is seriously suicidal.
Such steps would include, but not be limited to, notifying the student's
parent/s or guardian of the danger. Such a rule might not have prevented the
Virginia Tech or Northern Illinois killings; on the other hand, it might save the
lives of many deeply troubled young people, and it could even stop a suicidal
student who was determined to "take others with him",4 as he played out his
grim purpose. I. INTRODUCTION In 2002, the academic world,6 as well as
much of the nation, was shocked7 by the cover story of the New York Times
Magazine of April Landscape: Privacy, Disability Laws Restrict Actions, WASH.
POST, Apr. 19, 2007, at All; Donald Rosen, Letter to the Editor, Screening
Students for Mental Health, CHRON. HIGHER EDUC. (Wash., D.C.), May 25,
2007, at B13; Robert B. Smith & Dana L. Fleming, Student Suicide and
Colleges' Liability, CHRON. HIGHER EDUC. (Wash., D.C.), Apr. 20, 2007, at
B24; Paula Wasley, Group Sets Guidelines on Troubled Students, CHRON.
HIGHER EDUC. (Wash., D.C.), May 25, 2007, at A47 (noting "a list of best
practices.., for colleges and universities in dealing with students with mentalhealth problems," released the week before by the Bazelon Center for Mental
Health Law); Amanda Schaffer, Stopping Suicide 101: The Dilemma of College
Students Who Threaten to Kill Themselves, SLATE, May 26, 2006,
http://www.slate.com/id/2142373. These articles do not reference the events
at Virginia Tech, but they did follow very shortly after that incident took place.
4. Julie Jennings, Ph.D., Public Speech on "Suicide" at the Rockbridge County
Regional Library (May 8, 2007) (highly regarded local therapist posited that
the behavior of both Seung-Hui Cho and the Columbine killers manifested a
deeply suicidal nature in which the death wish included a desire to "take
others with them"). For support for this thesis, see, e.g., GARY PAVELA,
QUESTIONS AND ANSWERS ON COLLEGE STUDENT SUICIDE: A LAW AND
POLICY PERSPECTIVE 139 (2006) (quoting the "suicidal rage" Columbine killer
Eric Harris expressed on his AOL website: "I don't care if I live or die in the
shoot-out. All I want to do is to kill and injure as many of you... as I can....");
Rex Bowman & Bill McKelway, Panel Gets Tech Killer's Records, RICHMOND
TIMES DISPATCH (Richmond, Va.), June 15, 2007, at A-1 (referring to Cho's
initial contact with Virginia mental-health system on December 13, 2006,
after a roommate reported that Cho had become suicidal). 5. See Bowman &
McKelway, supra note 4; see also A Shooter's Signals, supra note 2 (noting
that university police at Virginia Tech obtained a detention order from a local
magistrate in December 2005 against Seung-Hui Cho on the grounds that he
might have been suicidal, after which "he was briefly admitted to a mental
health center"). 6. E.g., Joel Epstein, Breaking the Code of Silence: Bystanders
to Campus Violence and the Law of College and University Safety, 32
STETSON L. REV. 91, 107 (2002); Peter Lake & Nancy Tribbensee, The
Emerging Crisis of College Student Suicide: Law and Policy Responses to
Serious Forms of Self-Inflicted Injury, 32 STETSON L. REV. 125, 125 n.3
(2002); Peter F. Lake, Private Law Continues to Come to Campus: Rights and
Responsibilities Revisited, 31 J.C. & U.L. 621,634 n.135 (2005). 7. Elizabeth
Shin's suicide drew a great deal of attention in the popular press. See, e.g.,
20081 MARQUETTE LAW REVIEW [91:625 28, which asked, "Who Was
Responsible for Elizabeth Shin?" and went on to detail the Massachusetts

Institute of Technology ("MIT") sophomore's suicide in April 2000 by selfimmolation in her dormitory room, just one day after her family had dropped
in to celebrate her nineteenth birthday.8 The night before that visit, Elizabeth
had attempted to stick a knife in her chest, but lost her nerve at the last
minute. Her friends, the mental health center, and several MIT
administrators9 all knew of this incident. Other college officials were aware of
prior suicidal threats and attempts.' Later the same night as the impromptu
birthday party, Elizabeth told a friend she was going to commit suicide and
asked him to erase her computer files; a campus mental health professional
and the dorm master decided to let her sleep off the non-lethal mixture of
alcohol and Tylenol. The next night, she succeeded in her aim, by a means
more gruesome than anyone had imagined." David Abel & John Ellement,
Student Burned in Reported Suicide Attempt at MIT, BOSTON GLOBE, Apr. 12,
2000, at B4; Eric Convey & Doug Hanchett, MIT Student, 19, Dies from Burns
Suffered in Dormitory Fire, BOSTON HERALD, Apr. 15, 2000, at 6; Kevin
Coughlin, Probe Finds MIT Student Killed Herself, STAR-LEDGER (Newark, N.J.),
May 31, 2000, at 23; Julie Flaherty, Suit on M.L T. Suicide, N.Y. TIMES, Jan. 29,
2002, at A18; Patrick Healy, $27M Suit over Suicide at MIT Hits Privacy Rules,
BOSTON GLOBE, Jan. 29, 2002, at Al; Rochelle Sharpe, Parents' Fury at MIT: A
Study of Mental Illness on Campus, USA TODAY, Jan. 25, 2002, at IA; Good
Morning America: Interview with Kisuk Shin and Cho Hyun Shin, Elizabeth
Shin's Parents, and David DeLuca, Attorney (ABC television broadcast Jan. 28,
2002) (discussing Elizabeth's suicide and MIT's responsibility in it).
Additionally, whenever I have mentioned Elizabeth Shin in class, invariably,
some of my students are aware of the incident. 8. Deborah Sontag, Who Was
Responsible for Elizabeth Shin? N.Y. TIMES, Apr. 28, 2002 (Magazine), at 56. 9.
These included Associate Dean Arnold Henderson and Nina Davis-Millis, the
housemaster at Random Hall, where Elizabeth lived. Shin v. MIT, No. 02-0403,
2005 WL 1869101, at *4-5 (Mass. Super. June 27, 2005) (order granting
partial summary judgment); see Complaint 33, Shin v. MIT, 2002 WL
34214754 (Mass. Super. Jan. 28, 2002) (No. 02-0403). 10. During the second
semester of her freshman year, she overdosed on fifteen Tylenol with codeine
tablets and was rushed to the hospital by the campus police. During the first
semester of her sophomore year, she met with a dean and showed him a half
dozen selfinflicted cut marks on her arm. She later sent an email message to
a professor, saying that she bought some sleeping pills, which were
discovered by a friend before Elizabeth could take any. During the next
semester her dorm master rushed her to the health center after she was
reportedly upset and in possession of a knife. On another occasion she
confessed to a school doctor that she had thoughts about hanging herself or
bleeding to death. Later she told a dean that "she thinks she may not live
long enough [to worry about long-term plans], that she might just end it one
day." In April, the campus police took her to the health center after her
friends reported that she wanted to stick a knife in her chest. The night
before Elizabeth died, a friend reported to the dorm master that Elizabeth
said she was preparing to kill herself with alcohol and Tylenol. Sontag, supra
note 8, at 94, 139. 11. Id. at 139. SUICIDE ON CAMPUS In the wake of
Elizabeth's death, her parents-seemingly, her only acquaintances who were
not aware of her fragile state-sued the school for its failure to notify them of
their daughter's precarious mental condition and its failure to take effective
steps to prevent her tragic death. 2 Named defendants included not only the
counselors involved in Elizabeth's treatment (basically, medical malpractice
claims) but also MIT itself, as well as two of its non-clinician administrators

who had dealt directly with Elizabeth. To the surprise and great consternation
of much of academia, 3 on June 27, 2005, Christine M. McEvoy, Justice of the
Superior Court for Middlesex County, Massachusetts, while granting MIT's
motion for summary judgment, denied similar motions filed on behalf of Dean
Arnold Henderson, an associate dean in the office of the Dean for Student
Life, and Nina Davis-Millis, a librarian at MIT and housemaster of Elizabeth's
dormitory. 4 Trial was set for May 1, 2006.15 Given the Shins' unusual victory
to that point, it was particularly surprising that on April 3, 2006, MIT and the
Shin family jointly announced a resolution of the lawsuit, involving a
settlement of an undisclosed sum. In addition to withdrawing their claims
against the MIT administrators, the Shins agreed to drop their action against
four MIT psychiatrists. Most surprising, however, was Mr. Shin's statement
that "[w]e ... have come to understand that our daughter's death was likely a
tragic accident."' 6 Gary Pavela, a University of Maryland 12. See Complaint,
Shin v. MIT, supra note 9. 13. Interested parties have variously described the
ruling's "in terrorem effect on colleges across the nation" as having "turn[ed]
settled tort law on its head," Brief of Amici Curiae Brown University et al. in
Support of Petition for Relief Under G.L. ch. 231, 118 (First Paragraph) by
MIT Administrators Arnold Henderson and Nina Davis-Millis at 4, Shin v. MIT,
No. 2006-J-0099 (Mass. Super. Feb. 24, 2006) [hereinafter Nat'l Colleges
Brief]; that the effect is "already being felt" and "adversely affecting"
administrator performance, Memorandum of Amici Curiae Amherst College et
al. in Support of the Petition for Relief Under G.L. ch. 231, 118 (First
Paragraph) by MIT Administrators Arnold Henderson and Nina Davis-Millis at
3, Shin v. MIT, No. 2006-J-0099 (Mass. Super. Feb. 24, 2006) [hereinafter
Mass. Colleges Brief]; and as engendering "massive and unpredictable
liability," Motion of American Council on Education et al. for Leave to File Brief
Amici Curiae in Support of MIT Administrators Arnold Henderson and Nina
Davis-Millis' Petition for Relief Under G.L ch. 231, 118 (First Paragraph) at 4,
Shin v. MIT, No. 2006-J-0099 (Mass. Super. Feb. 24, 2006) [hereinafter Ass'n
Motion]. 14. Shin, 2005 WL 1869101, at *1 (order granting partial summary
judgment in favor of MIT itself). 15. Opposition to the Motions of Nominal
Amici Curiae for Leave to File Briefs and/or Motion to Strike Briefs of NonParties at 2, Shin v. MIT, No. 2006-J-0099 (Mass. App. Ct. Mar. 1, 2006)
[hereinafter Shin Brief]. 16. Press Release, Massachusetts Institute of
Technology, Agreement Reached by MIT and the Shin Family (Apr. 3, 2006)
(on file with MIT News Office), available at 2008] MARQUETTE LAW REVIEW
professor and noted authority on higher education law, particularly as it
pertains to student suicides, 7 spoke for many of us interested bystanders: "'I
am surprised to see a suggestion that the Elizabeth Shin "suicide" was an
accident. That muddies the waters .... It also means the lower court ruling on
summary judgment will be cited rarely, if at a ll.'" 18 With respect to
Professor Pavela's last prediction, I beg to disagree. We may never know for
sure whether the death of Elizabeth Shin was a result of her intentional action
or "a tragic accident," but writers referring to the Shin case since the April
2006 press release continue to assume it was the former. 9 Moreover, the
legal issues raised in the case, predicated on the presumption of suicide,
appear likely to recur, and Judge McEvoy's opinion could hardly be ignored.20
A similar case involving a student at Ferrum College in Franklin County,
Virginia,2' was settled after a federal judge found a basis for permitting the
action to go forward. In a statement, the school "acknowledged that 'errors in
judgment and communication by school personnel' were partly responsible
for the suicide. 2 2 Said Federal District Judge Jackson Kiser, "it is true that

colleges are not insurers of the safety of their students.... Nonetheless,

'[p]arents, students, and the general community still have a reasonable
expectation, fostered in part by colleges themselves, that reasonable care
will be exercised to protect resident students from
http://web.mit.edu/newsoffice/2006/lawsuit-statement.html; Marcella
Bombardieri, Parents Strike Settlement with MIT in Death of Daughter,
BOSTON GLOBE, Apr. 4, 2006, at B1; see also Jonathan D. Glater, Settlement
Reached in Student's Death, N.Y. TIMES, Apr. 4, 2006, at A20. 17. See infra
notes 175-78 and accompanying text (discussing Professor Pavela's ideas in
greater detail). 18. Caryn Meyers Fliegler, A Disquieting Accident at MIT, U.
Bus., May 2006, at 13 (quoting Gary Pavela). 19. See, e.g., Elizabeth
Bernstein, After a Suicide, Privacy on Trial, WALL ST. J., Mar. 24, 2007, at Al;
Chute, supra note 2; Kinzie, supra note 3; Parents' Right to Know, supra note
2; Plunkett, supra note 2; Schaffer, supra note 3; Smith & Fleming, supra note
3; Ulferts, supra note 2; Sarah Elizabeth Richards, The Suicide Test, SALON,
Mar. 9, 2007, http://salon.com/mwt/feature/2007/03/09/suicide/index.html.
20. For this reason, and because the relevant documents in Shin v. MIT
presume suicide, the remainder of this paper will, for purposes of the
argument, assume likewise. 21. Schieszler v. Ferrum Coll., 236 F. Supp. 2d
602, 609 (W.D. Va. 2002) (holding that a special relationship existed between
the student and the college because alleged facts showed that there was "'an
imminent probability' that [the student] would try to hurt himself, and that
the defendants had notice of this specific harm"). 22. Jen McCaffery, Ferrum
College Admits Fault in Student Suicide, ROANOKE TIMES (Roanoke, Va.), July
25, 2003, at Al. [91:625 SUICIDE ON CAMPUS foreseeable harm.' ' 23 Judge
Kiser based his ruling on his finding of a "special relationship" between the
suicidal student and the school, established in Restatement (Second) of Torts
section 314A;24 Judge McEvoy based her summary judgment denial on the
grounds that such a "special relationship" could exist between Elizabeth and
the nonclinician administrators who, knowing of Elizabeth's imminent suicidal
threats, failed to take steps to protect her from self-harm.25 The situation of
the young people in these cases was not unique. Suicide among college
students, the second leading cause of death in this group, has risen
dramatically in recent decades.26 This Article sides with the judges cited
above, and takes the position that, where college or university personnel are
aware that a student has made serious suicidal threats or attempts, they
have a duty to take reasonable steps to protect the student's safety. Where
emergent circumstances appear to existi.e., where the threat would appear
to the reasonable non-clinician to be serious or even imminent-that duty
extends at least to the notification of parents or other responsible family
members concerning the student's mental welfare and may also include more
positive actions, depending upon what is reasonable under the
circumstances. As the judges in both Schieszler v. Ferrum College and Shin v.
MIT held, this duty arises under current tort law doctrine, Restatement
(Second) of Torts section 314A, which recognizes a duty to give aid when a
"special relation" exists between the defendant and the person injured.
Notably, the Restatement (Third) of Torts section 40, adopted by the
American Law Institute in May 2005,27 specifically lists "a school with its
students" as one of the "special relations" giving rise to "a duty of reasonable
care with regard to risks that arise within the scope of the relationship."2
Against the protest that such a "special relation" does not exist, at least 23.
Schieszler, 236 F. Supp. 2d at 610 (quoting Mullins v. Pine Manor College, 449
N.E.2d 331, 336 (Mass. 1983)). 24. Id. at 606-10; RESTATEMENT (SECOND) OF

TORTS 314A (1965). 25. Shin v. MIT, No. 02-0403, 2005 WL 1869101, at
*12-13 (Mass. Super. June 27, 2005); RESTATEMENT (SECOND) OF TORTS
314A (1965). Significantly, Judge McEvoy also denied summary judgment to
plaintiffs, which would have required a finding that a "special relationship" did
exist. 26. See infra notes 34-40 and accompanying text. 27. AM. L. INST.,
ACTIONS TAKEN WITH RESPECT TO DRAFTS SUBMITrED AT 2005 ANNUAL
MEETING 34, https://www.ali.org/ali/AM05ActionsTaken.pdf. 28. RESTATEMENT
(THIRD) OF TORTS: LIABILITY FOR PHYSICAL HARM 40 (Proposed Final Draft
No. 1, 2005) (Section 40 replaces section 314A of Restatement (Second) of
Torts). Comment I to section 40 confirms that "students" includes college-age
students. For further discussion, see infra notes 61-71 and accompanying
text. 20081 MARQUETTE LAW REVIEW not with respect to adult-age college
students, and that furthermore, an adult student's privacy rights preclude
notification of family without the student's consent, this Article argues that
theories of corrective justice, reflecting general notions of morality, support
legal recognition of such a duty; moreover, the "emergency" exception to
federal privacy laws easily applies when a student is seriously suicidal. In
fact, Congress has before it a highly desirable bill that would amend the law
to clarify that point. 9 Finally, burgeoning knowledge about psychological and
emotional development during the late teens and early twenties tells us that
this period of life is a time when mental instability-and indeed, serious mental
illness-often first emerge. Together with the fact that persons of this age have
not yet developed higher judgmental faculties, this vulnerability buttresses
arguments that institutions of higher learning should be held accountable for
their actual awareness of seriously suicidal students and should be deemed
to have a legal duty of care to take reasonable steps to prevent those
tragedies. II. SCOPE AND NATURE OF THE PROBLEM Suicides on college
campuses make news. Perhaps because we deplore the waste of such
talented and promising young lives,3 " perhaps because we think this group
of people is among our more fortunateand therefore, we are all the more
mystified 31 -or sometimes perhaps because they seem to come in clusters
on certain campuses,32 the suicides of college and university students
receive intense publicity and have been the subject of widespread study in
recent years." 29. Mental Health Security for America's Families in Education
Act of 2007, H.R. 2220, 110th Cong. (as referred to House Committee on
Education and Labor, May 8, 2007); see also Jerome L. Sherman, Bill Would
Share Student Mental Data with Parents, PITT. POSTGAZETTE, Apr. 30, 2007,
at A-4. 30. See, e.g., RALPH L.V. RICKGARN, PERSPECTIVES ON COLLEGE
STUDENT SUICIDE 39 (1994) ("[Suicide's] especial importance as affecting a
group so highly selected as the college population, potentially so significant
to society relative to later role and function, certainly is not to be gainsaid."
(quoting T. Raphael et al., The Question of Suicide as a Problem in College
Mental Hygiene, 7 AM. J. ORTHOPSYCHIATRY 1, 1 (1937))). 31. Ann Pollinger
Haas et al., Suicide in College Students, 46 AM. BEHAV. SCIENTIST 1224, 1224
(2003) (remarking upon the perplexing suicidality of college students, an
otherwise seemingly privileged segment of society). 32. Kate Kelly, Lost on
the Campus, TIME, Jan. 15, 2001, at 51, 51 (noting that four MIT students had
committed suicide in the previous three years); Daniel McGinn & Ron
Depasquale, Taking Depression on, NEWSWEEK, Aug. 23, 2004, at 59, 59
(reporting that four N.Y.U. students had leapt to their deaths the previous
year). 33. One study observes that the "intense media scrutiny" of college
suicides is due in part to the few well known lawsuits brought by parents of
students who committed suicide. [91:625 2008] SUICIDE ON CAMPUS Suicide

is now the second leading cause of death among college students in the
United States, after accidents. 4 It is the third leading cause of death among
young people ages fifteen to twenty-four.35 Since the 1950s, the suicide rate
among males in that age category has tripled, while for females, it has
doubled.36 Among undergraduate students, specifically, the suicide rate,
which peaks at ages twenty to twenty-four,37 is generally 7.5 per 100,000
students"--meaning that we can anticipate Haas et al., supra note 31, at 1230
(Haas and her two co-authors, Herbert Hendin and J. John Mann, are
associated with the American Foundation for Suicide Prevention); see also
Lisa C. Barrios et al., Suicide Ideation Among US College Students, 48 J. AM.
C. HEALTH 229 (2000); Susan R. Furr et al., Suicide and Depression Among
College Students: A Decade Later, 32 PROF. PSYCHOL.: RES. & PRAC. 97
(2001); Peter M. Gutierrez et al., Suicide Risk Assessment in a College
Student Population, 47 J. COUNSELING PSYCHOL. 403 (2000); Lisa C. Konick &
Peter M. Gutierrez, Testing a Model of Suicide Ideation in College Students, 35
SUICIDE & LIFE-THREATENING BEHAV. 181 (2005); Karen Arenson, Suicide of
N.Y.U. Student, 19, Brings Sadness and Questions, N.Y. TIMES, Mar. 10, 2004,
at B2; Kelly, supra note 32; McGinn & Depasquale, supra note 32; Today:
Profile: Suicide Incidence on College Campuses (NBC television broadcast Oct.
19, 2004). 34. NAT'L MENTAL HEALTH ASS'N & JED FOUND., SAFEGUARDING
YOUR STUDENTS AGAINST SUICIDE 2 (2002) [hereinafter NMHA & JED
FOUND.], available at http://www.mentalhealthamerica.net/go/suicide (follow
"Young People and Suicide: Safeguarding Your Students Against Suicide"
hyperlink; then follow "Download Report" hyperlink). The Jed Foundation is a
nonprofit charity aimed at preventing suicide among young people. It was
created by Phil and Donna Satow after their son Jed committed suicide as a
University of Arizona sophomore in 1998. The Jed Foundation, History,
http://www.jedfoundation.org/foundation history.php (last visited Apr. 12,
2008). 35. Centers for Disease Control and Prevention, Suicide Facts at a
Glance (2007), http://www.cdc.gov/ncipc/dvp/suicide/suicidedatasheet.pdf;
Nat'l Inst. of Mental Health, Suicide in the U.S.: Statistics and Prevention,
http://www.nimh.nih.gov/publicat/harmsway. cfm (last visited Apr. 12, 2008).
The second leading cause of death is homicide. U.S. CENSUS BUREAU,
STATISTICAL ABSTRACT OF THE UNITED STATES: 2004-2005, at 82 tbl.105,
available at http://www.census.gov/prod/2004pubs/04statab/vitstat.pdf. 36.
Haas et al., supra note 31, at 1224-25; see also NMHA & JED FOUND., supra
note 34, at 2 (noting that in the past sixty years the overall rate has tripled).
37. Elizabeth Fried Ellen, Suicide Prevention on Campus, 19 PSYCHIATRIC
TIMES, Oct. 2002, at 1; NMHA & JED FOUND., supra note 34, at 3 tbl.1;
SUICIDE PREVENTION RES. CTR., PROMOTING MENTAL HEALTH AND
PREVENTING SUICIDE IN COLLEGE AND UNIVERSITY SETTINGS 5 (2004),
available at http://www.sprc.org/library/college-sp-whitepaper.pdf. 38. See,
e.g., Karen W. Arenson, Worried Colleges Step up Efforts over Suicide, N.Y.
TIMES, Dec. 3, 2004, at Al; Elizabeth Fried Ellen, Identifying and Treating
Suicidal College Students, 19 PSYCHIATRIC TIMES, Aug. 2002, at 1; SUICIDE
PREVENTION RES. CTR., supra note 37, at 5; NMHA & JED FOUND., supra note
34, at 3 tbl.2. These figures come from Morton M. Silverman et al., The Big
Ten Suicide Study: A 10-Year Study of Suicides on Midwestern University
Campuses, 27 SUICIDE & LIFE-THREATENING BEHAV. 285 (1997). Although
Silverman acknowledges the study's limitations, noting that the Big Ten
schools are located in the Midwest-a region that has a lower suicide rate than
the national average-and that a large number of former students who
committed suicide were not included in the sample, his numbers are

generally accepted. Id. at 296-99. Other possible limitations of the study are
discussed in Haas et al., supra note 31, at 1226-28 ("The failure to include as
MARQUETTE LAW REVIEW between 1,000 and 1,100 such deaths per year. 39
The dramatic increase in these numbers over the past half-century, ' plus the
attendant negative publicity, 4 ' has motivated a number of colleges and
universities to increase their psychological counseling services and to initiate
programs to target students at serious risk. 2 Probably the most systematic
effort has been the collaboration of Emory University with the American
Foundation for Suicide Prevention, which has resulted in an online screening
device, the "College Screening Project: A Program to Identify and Help
Students With Significant Psychological Problems. 43 The College Screening
Project invites students to log on anonymously and complete a survey
measuring markers for psychological disturbance, especially depression (the
most common diagnosis among young people who commit or contemplate
suicide)." When a student responds to the site, the student's answers are
reviewed by a clinically trained counselor or therapist, who sends a
personalized evaluation to the student's log-in ID." Where a student appears
to be at risk, he or she is strongly encouraged to arrange a personal
consultation with a mental healthcare 'college suicides' the undetermined
[but unusually high rate] of young people who kill themselves after dropping
out of school artificially lowers the 'college' rate ... "). 39. See, e.g., NMHA &
JED FOUND., supra note 34, at 2 (pinpointing the anticipated number at
1,088). 40. Haas et al., supra note 31, at 1224-25. 41. See, e.g., Patrick
Healy, 11 Years, 11 Suicides: Critics Say Spate of MIT Jumping Deaths Shows
a "Contagion," BOSTON GLOBE, Feb. 5, 2001, at Al (reporting that several MIT
students say a "culture of suicide" has developed on campus). For a shocking
example, see Jeane MacIntosh & Andy Geller, Death Plunge No. 4: NYU's
Grief, N.Y. POST, Mar. 10, 2004, at 1 (displaying a front-cover photograph of
the student falling from the building). Unfortunately many college
administrators are too focused on university reputation and view student
suicides as a public relations problem rather than a student health concern.
Haas et al., supra note 31, at 1236. 42. Arenson, supra note 33; Kim Painter,
Colleges Throw Lifeline to Students, USA TODAY, Mar. 3, 2004, at 1D; Ernest
Sander, Some Colleges Try Zero-Tolerance Toward Suicide Attempts, WALL ST.
J., Oct. 15, 2004, at B1. 43. Haas et al., supra note 31, at 1231; Ellen, supra
note 38, at 1. 44. Haas et al., supra note 31, at 1232; see also Konick &
Gutierrez, supra note 33, at 189 (finding depression a better predictor of
suicidal thoughts than either hopelessness or negative life events); Allan J.
Schwartz, The Epidemiology of Suicide Among Students at Colleges and
Universities in the United States, in COLLEGE STUDENT SUICIDE 25, 39-40
(Leighton C. Whitaker & Richard E. Slimak eds., 1990) (stating that eighty-five
percent of college suicides result from depression). Contra Furr et al., supra
note 33, at 98 (hopelessness); John S. Westefeld et al.. College and University
Student Suicide: Trends and Implications, 18 COUNSELING PSYCHOLOGIST
464, 468 (1990) (hopelessness and pressure to succeed). 45. Haas et al.,
supra note 31, at 1232. [91:625 SUICIDE ON CAMPUS professional. If the
student prefers not to do this, he or she may continue to pose questions
online and receive help and encouragement.' Initial results from the College
Screening Project appear promising: Not only have significant numbers of the
targeted population responded positively to the program, but the increased
awareness of the problem on the part of students and college personnel is
thought to help bring into the open and thereby de-stigmatize major mental
health issues. After its initial tryout at Emory, the program was subsequently

pilottested at the University of North Carolina at Chapel Hill.4s Both

institutions continue to use the test, which has been expanded to MIT,
Morehouse College, the University of Pittsburgh, and Vanderbilt; several
schools have invited talks with the American Foundation for Suicide
Prevention to focus on graduate or medical students. 9 A similar device,
already accessible to all, has been established by The Jed Foundation, a
nonprofit charity aimed at preventing suicide among young people.0 The
Foundation's website contains a link to Ulifeline.org, where students can log
on to connect to a number of mental health sites. One of these is the Duke
Diagnostic Psychiatry Screening Program, which screens students for various
psychiatric disorders. As with the College Screening Project, students can
remain anonymous; further links tell them about the counseling services
available at their particular schools." Highlighting the need for such programs
(and perhaps testifying to their effectiveness) is the fact that campus
counseling centers have seen dramatic increases in their caseloads over just
the past few years; 46. Id. 47. Id. at 1233; see Ellen, supra note 38, at 4
(reporting that many Emory students have been surprised that seeing a
psychiatrist was not "as big a deal" as they expected). The myth that talking
about suicide will give the person the idea is, one author states, "the greatest
deterrent of proactive suicide prevention and intervention." RICKGARN, supra
note 30, at 89. 48. Ellen Freedman, The American Foundation for Suicide
Prevention: Initiatives in College Suicide Prevention, SPARK, Oct. 22, 2004,
http://www.sprc.org/thespark/spotlight.asp. 49. Rob Capriccioso, Using the
Web to Prevent Suicide, INSIDE HIGHER ED, Sept. 20, 2006,
http://www.insidehighered.com/news/2006/09/20/counseling (describing
program and reporting expansion); Lynne Lamberg, Experts Work to Prevent
College Suicides, 296 JAMA 502, 503 (2006) (reporting discussion of program
at the annual meeting of the American Psychiatric Association in May 2006,
which included a symposium on campus suicide). 50. Ellen, supra note 38, at
7. 51. Id. The Jed Foundation is also collaborating with the University of
Rochester's Center for the Study and Prevention of Suicide on a college
suicide prevention program for use on college campuses to "strengthen social
networks and support systems" for students. The Jed Foundation, Pilot
Program to Promote Mental Health and Prevent Suicide,
http://www.jedfoundation.org/programs-colleges-prevention.php (last visited
Apr. 15, 2008). 20081 MARQUETTE LAW REVIEW [91:625 moreover, the
students they are seeing are reportedly sicker and more often in need of
hospitalization than used to be the case. 2 This phenomenon is in part
attributable to the fact that more adolescents with mental health problems
receive diagnosis and treatment in their high school years.53 Many of these
young people would not have been viable college candidates in the past;
now, they are arriving on campuses in need of continuing care or, at the very
least, watchfulness." For some, departure from home plus the stressors of a
new social environment and academic pressures may prove to be more than
they can handle, at least not without substantial help.5 Another important
factor in the campus suicide picture is that a number of serious psychiatric
disorders typically emerge in the late teens or early twenties. 6 Institutions of
higher learning are well situated 52. In 2004, eighty-five percent of student
counseling center directors reported an increase in recent years in students
with "severe psychological problems." ROBERT P. GALLAGHER, NATIONAL
SURVEY OF COUNSELING CENTER DIRECTORS 2 (2004), available at
http://iacsinc.org/2004%20Survey%20final-l.pdf. In 1990, only fifty percent of
student counseling center directors reported an increase. Haas et al., supra

note 31, at 1228-29. Richard Kadison, M.D., psychiatrist and head of Harvard
University Health Services, observed, "Every director of every college
counseling center is reporting more hospitalizations, more serious problems,
and taking sicker students." Hara Estroff Marano, Crisis on the Campus,
PSYCHOL. TODAY, May 2, 2002, http://psychologytoday.com/articles/pto20030501-000005.html. 53. NMHA & JED FOUND., supra note 34, at 5
(dividing at-risk students into two major groups: those with previous
psychological problems and those without such histories); see also Ellen,
supra note 37, at 5 ("Today's colleges and universities also are drawing many
more students who arrive on campus with diagnosed mental illnesses.");
Mary Duenwald, The Dorms May Be Great, but How's the Counseling?, N.Y.
TIMES, Oct. 26, 2004, at F1 ("Sometimes, students who suffered an episode
of mental illness in high school or earlier will experience a recurrence in
college."); Kelly, supra note 32, at 52 (noting widespread use of
antidepressants such as Prozac and Zoloft); Marano, supra note 52 ("A
decade of improved drugs has encouraged earlier diagnosis [of mental
illnesses]."). 54. Kelly, supra note 32, at 52. One observer calls this trend the
"Prozac payoff." Marano, supra note 52; cf. Haas et al., supra note 31, at 1229
(increase on campus of students with mental disabilities in part due to
accessibility requirements of the 1990 Americans with Disabilities Act); see
also infra notes 158-59 and accompanying text. 55. Ellen, supra note 37, at 5
("[W]hile many [students who arrive at college with diagnosed mental illness]
can and do thrive, there is still a segment of this population that may be
particularly vulnerable to the stressors inherent in college."); NMHA & JED
FOUND., supra note 34, at 5 ("[T]he nature of the campus environment itself
may serve to exacerbate any existing symptoms or engender the expression
of emotional or behavioral disorders in those students who may be
predisposed to mental illness."). 56. Ellen, supra note 37, at 4 ("Severe
psychiatric disorders such as bipolar disorder and schizophrenia typically first
manifest themselves between the ages of 18 and 24 years and can easily
derail the lives of students. Major depression, posttraumatic stress disorder
and personality disorders also can be extremely disruptive."). For a fuller
discussion, see infra note 165 and accompanying text. SUICIDE ON CAMPUS
to spot such developing problems and provide the necessary support, a fact
to which one expert attributes the lower rate of suicide in this group than in
the general population. 7 No one could reasonably expect colleges to be
guarantors of their students' safety-even for those in their active counseling
care-so it is discouraging to read that one problem encountered by the
College Screening Project has been "the unanticipated reluctance on the part
of many university officials to know the actual identity of suicidal students,
believing that not knowing will protect the institution from liability in the
event of a student's suicide." ' III. THE CASE FOR LIABILITY: TORT LAW A.
Restatement (Second) of Torts Section 314A and Restatement (Third) of Torts
Section 40: "Special Relationships" As every law student learns in the first
year, there is no general "duty to rescue" a person in even the gravest
danger if the actor has no control over that person and did not create the
danger, regardless of how easy and risk-free it would be for the actor to do
so. 9 An exception to this general principle lies in the concept of Restatement
(Second) of Torts section 314A, which provides that certain "special relations"
between the actor and the person in danger of harm give rise to a duty in the
former to "take reasonable action" to protect the latter "against unreasonable
risk of physical harm." 6 Further, the actor must provide "first aid" once "it
knows or has reason to know that [the person in 57. Silverman et al., supra

note 38, at 299. Other factors include easier access to low-cost mental health
services, existence of greater peer support, campus-wide bans of firearms
and illicit drugs, regulation of alcohol use, freedom from cares of workaday
world, and purposedriven education. Id. at 299, 300; see also Schwartz, supra
note 44, at 39-40 (reviewing previous studies and suggesting that the rate of
college student suicide is likely lower than the national average). Schwartz
attributes the lower rate to the absence of firearms on campus. Id. at 41. 58.
Haas et al., supra note 31, at 1234. 59. RESTATEMENT (THIRD) OF TORTS:
LIABILITY FOR PHYSICAL HARM 37 (Proposed Final Draft No. 1, 2005) ("An
actor whose conduct has not created a risk of physical harm to another has
no duty of care to the other unless a court determines that one of the
affirmative duties . . . is applicable."); RESTATEMENT (SECOND) OF TORTS
314 (1965). ("The fact that the actor realizes or should realize that action on
his part is necessary for another's aid or protection does not of itself impose
upon him a duty to take such action."). See also W. PAGE KEETON ET AL.,
PROSSER AND KEETON ON THE LAW OF TORTS 56, at 373 (5th ed. 1984)
("[T]he law has persistently refused to impose on a stranger the moral
obligation of common humanity to go to the aid of another human being who
is in danger, even if the other is in danger of losing his life."). 60.
RESTATEMENT (SECOND) OF TORTS 314A(1)(a). 20081 MARQUETTE LAW
REVIEW 'special relation' is] ill or injured, and to care for [the person] until
[the person] can be cared for by others. '' 6 ' Actors to whom section 314A is
specifically applicable are common carriers, innkeepers, landowners with
respect to their business invitees, and custodians of others. A caveat to the
section states, however, that "[t]he [American Law] Institute expresses no
opinion as to whether there may not be other relations which impose a
similar duty." 63 Comment b notes, "The relations listed are not intended to
be exclusive, and are not necessarily the only ones in which a duty of
affirmative action for the aid or protection of another may be found." 64
Comment c provides the limiting principle that "[t]he rules stated in this
Section apply only where the relation exists between the parties, and the risk
of harm, or of further harm, arises in the course of that relation., 65
Importantly, the source of the harm is irrelevant: "The duty to give aid to one
who is ill or injured extends to cases where the illness or injury is due to
natural causes, to pure accident, to the acts of third persons, or to the
negligence of the plaintiff himself.. . ."66 Restatement (Third) of Torts, in its
Chapter 7 on "Affirmative Duties," expands upon the prior Restatement's
language. Section 40 of Restatement (Third) provides: (a) An actor in a
special relationship with another owes the other a duty of reasonable care
with regard to risks that arise within the scope of the relationship. (b) Special
relationships giving rise to the duty provided in Subsection (a) include: 67 (5)
a school with its students .... Comments to this revision of the "special
relationship" provision make clear that the duty of care imposed goes beyond
the "first aid" or "temporary care" contemplated by Restatement (Second): "A
duty of 61. Id. 314A(1)(b). 62. Id. 314A(1)-(4). Examples of custodial
relationships include jailer-prisoner and school-schoolchildren. Id. 314A illus.
6-7. 63. Id. 314A Caveat. 64. Id. 314A cmt. b. 65. Id. 314A cmt. c. 66. Id.
314A cmt. d. 67. RESTATEMENT (THIRD) OF TORTS 40(a), (b)(5) (Proposed
Final Draft No. 1, 2005). [91:625 SUICIDE ON CAMPUS reasonable care is
flexible enough to account for a wide variety of situations. Nevertheless, the
duty imposed requires only reasonable care under the circumstances." The
source of the risk triggering the duty is irrelevant and may even include the
intentional act of the plaintiff, thereby eliminating the potential defense in a

suicide situation of supervening independent cause: "The duty described in

this Section applies regardless of the source of the risk. Thus, it applies to
risks created by the individual at risk as well as those created by a third
party's conduct, whether innocent, negligent, or intentional." 69 With respect
to the special relationship "between a school and its students," Comment I
notes that "what constitutes reasonable care is contextual-the extent and
type of supervision required of young elementary school pupils is
substantially different from reasonable care for college students." 70
Significantly, the American Law Institute here makes clear its intent to include
college students in its newly specified list of "special relationships," even
though most people in that category have reached the age of legal
adulthood. Under the cases decided to date, whether a special relationship
exists between a college or university and a student in any given situation
depends upon a number of factors. Most commonly, courts and
commentators cite some combination of the following: foreseeability of harm
to the plaintiff (generally conceded to be the most important consideration);
degree of certainty of harm to the plaintiff; burden upon the defendant to
take reasonable steps to prevent the injury; some kind of mutual dependence
of plaintiff and defendant upon each other, frequently (as in these cases)
involving financial benefit to the defendant arising from the relationship;
moral blameworthiness of defendant's conduct in failing to act; and social
policy considerations involved in placing the economic burden of the loss on
the defendant.71 68. Id. 40 cmt. d. The same comment declares that the
change "recognizes both the variety of situations in which the duty may arise
and advancements in medical technology that may enable an actor to
provide more than mere first aid." Id. 69. Id. 40 cmt. g. 70. Id. 40 cmt. 1.
71. See generally Tarasoff v. Regents of Univ. of Cal., 551 P.2d 334, 342 (Cal.
1976) (holding that university had duty to warn victim of student psychiatric
patient's intention to kill her). The opinion contains a "laundry list" of
considerations in determining affirmative duty-highlighting foreseeability as
most important-frequently cited by other courts. Id.; see, e.g., Eisel v. Bd. of
Ed. of Montgomery County, 597 A.2d 447, 448, 452-56 (Md. 1991) (using
Tarasoff list to find school counselors had duty to use reasonable means to
prevent suicide of thirteen-year-old girl); Mullins v. Pine Manor College, 449
N.E.2d 331, 336 (Mass. 2008] MARQUETTE LAW REVIEW Applying such
criteria, courts have varied in their willingness to find a special relationship
between a college or university and any given student. There is universal
recognition that the age of in loco parentis has passed 2 and that the duty, if
any, is not one of a general duty of care to all students in all aspects of their
collegiate life.73 Rather, courts have most often tended to find a legal duty of
care in situations that overlap or most closely parallel other recognized
examples of special relationship, such as landlord and tenant. For example, in
Mullins v. Pine Manor College, the Massachusetts Supreme Court found that a
residential college for women had a duty to provide for the security of its
students, including the protection of plaintiff from abduction and rape on the
campus.74 Said the court: Of course, changes in college life, reflected in the
general decline of the theory that a college stands in loco parentis to its
students, arguably cut against this view. The fact that a college need not
police the morals of its resident students, however, does not entitle it to
abandon any effort to ensure their physical safety. Parents, students, and the
general community still have a reasonable expectation, fostered in part by
colleges themselves, that reasonable care will be exercised to protect
resident students from foreseeable harm.75 Mullins was quoted with approval

by the Delaware Supreme Court in Furek v. University of Delaware,76 holding

the school liable for an oncampus fraternity hazing incident: 1983) (finding
that colleges voluntarily assume a duty of care to protect students from third
party attacks by charging them for tuition and residence fees). 72. See, e.g.,
Schieszler v. Ferrum Coll., 236 F. Supp. 2d 602. 608 (W.D. Va. 2002) ("[N]o
duty arises from an in loco parentis relationship between [the college] and
[the student]."); Furek v. Univ. of Del., 594 A.2d 506, 516 (Del. 1991) ("The
concept of university control based on the doctrine of in loco parentis has all
but disappeared in the face of the realities of modern college life .... "). 73.
Furek, 594 A.2d at 519-20 ("[T]here is no duty on the part of a college or
university to control its students based merely on the university-student
relationship."); Jain v. State, 617 N.W.2d 293, 297 (Iowa 2000) (commenting
that a "university's relationship with its students is not custodial in nature").
74. Mullins, 449 N.E.2d at 335-36. The court based its holding on
Restatement (Second) of Torts section 314A and an independent duty arising
from voluntary assumption, under Restatement (Second) of Torts section 323
(1965). 75. Id. 76. Furek, 594 A.2d at 520 (Del. 1991). Like Mullins, this case
also relied in part on other sections of the Restatement. See id. [91:625 2008]
SUICIDE ON CAMPUS In sum, although the University no longer stands in loco
parentis to its students, the relationship is sufficiently close and direct to
impose a duty under Restatement 314A. The university is not an insurer of
the safety of its students nor a policeman of student morality, nonetheless, it
has a duty to regulate and supervise foreseeable dangerous activities
occurring on its property.77 Other courts have not gone so far"8 and have
been especially reluctant to hold schools responsible where underage
drinking was involved in the incident.79 On the other hand, courts have often
found a special relationship, triggering a legal duty of care, between an
institution of higher learning and its athletes engaged in college-sponsored
activities.80 77. Id. at 522 (citing Mullins, 449 N.E.2d at 336); accord Knoll v.
Bd. of Regents of Univ. of Neb., 601 N.W.2d 757, 765 (Neb. 1999) (finding that
university as landowner owed duty of care to victim of fraternity hazing); see
also Nero v. Kan. State Univ., 861 P.2d 768, 777-79 (Kan. 1993) (finding that
university as landlord had duty to protect female student who was assaulted
in residence hall; the court cited Mullins and Furek, but alleged negligence
here was based more on a special relationship to the male who committed
the assault, on grounds that the university knew of his dangerous
propensities from a prior rape charge against him). 78. See Univ. of Denver v.
Whitlock, 744 P.2d 54, 62 (Colo. 1987) (finding that university owed no duty
of care to student who injured himself on a trampoline on lawn of fraternity
house leased from university); see also Talbot v. N.Y. Inst. of Tech., 639
N.Y.S.2d 135, 136-37 (N.Y. App. Div. 1996) (finding that college owed no duty
of care to residential student who was burned when rubber cement was
accidentally ignited by nearby cigarettes, in part because college students
are "'not young children in need of constant and close supervision"' (quoting
Mintz v. State, 362 N.Y.S.2d 619, 620 (N.Y. App. Div. 1975)). 79. See, e.g.,
Beach v. Univ. of Utah, 726 P.2d 413, 414 (Utah 1986) (concluding that
university owed no duty of care to student on professor-accompanied field
trip where underage plaintiff drank, became disoriented, and wandered off,
falling from a cliff and injuring herself); Bradshaw v. Rawlings, 612 F.2d 135,
137, 142 (3d Cir. 1979) (holding that the college owed no duty of care to
plaintiff injured in traffic accident caused by drunk classmate after offcampus sophomore class picnic, even though faculty member co-signed the
check for funds later used to buy the alcohol). 80. See, e.g., Davidson v. Univ.

of N.C., 543 S.E.2d 920, 927 (N.C. App. 2001) (university owed duty of care to
cheerleader injured performing dangerous stunt at school-sponsored team
practice with no supervision (citing RESTATEMENT (SECOND) OF TORTS
314A cmt. b)); Kleinknecht v. Gettysburg Coll., 989 F.2d 1360, 1370 (3d Cir.
1993) (recognizing that college owed duty of care based on special
relationship to lacrosse player who suffered fatal heart attack during
practice); see also Wallace v. Broyles, 961 S.W.2d 712 (Ark. 1998) (permitting
suit against individual university employees to go forward on grounds of both
negligence and wanton and willful conduct, where evidence tended to show
illegal administration by them to plaintiff of controlled substances which may
have contributed to his suicide). But see Klein v. Solomon, 713 A.2d 764 (R.I.
1998) (refusing to hold university vicariously liable for alleged negligent
referral of student by one of its counselors, where MARQUETTE LAW REVIEW
Obviously, the situation of a seriously suicidal student presents a different
kind of safety issue from those of residential security and appropriate
supervision of intercollegiate athletics. The landlord/tenant relationship,
which forms the basis for the residential security cases, may often obtain (as
was true in both Schieszler v. Ferrum College and Shin v. MIT), for college
administrators are most likely to be aware of the suicidal threat when the
student is physically on the premises where a responsible college employee
lives. It is not the landlord/tenant relationship per se, however, that gives rise
to the special relationship that creates the duty for school personnel to take
reasonable steps to prevent the student from self-inflicted harm. The most
important factor that triggers the duty here is foreseeability, arising from
actual knowledge of the student's serious-even imminent-suicidal threat. In
Schieszler, Judge Kiser emphasized the factual circumstances underlying the
special relationship envisioned by section 314A: the school had been warned
of several ongoing serious suicide threats by the decedent,81 and the dean of
students had even asked him to sign a statement that he would not hurt
himself."' In other words, the specific harm was highly foreseeable.
Additionally, the student resided on campus, where intervention was easy.
The judge cited several actions the school might have taken, including
affirmative steps to supervise him, to obtain counseling for him, or to contact
his guardian. 3 Actual knowledge of a specific threat to a student's safetywhether that threat emanates from a fellow student, a campus intruder, or
the student's own behavior-certainly passes the most rigorous foreseeability
test. The situation of threatened suicide may well give rise to a factual issue
over the imminence or veracity of the threat at the time. 4 Relevant
psychological literature does suggest, however, that such threats should
generally be taken seriously,5 and in both Schieszler student committed
suicide shortly thereafter). 81. Schieszler v. Ferrum Coll., 236 F. Supp. 2d 602,
609 (W.D. Va. 2002). 82. Id. 83. Id. at 610. 84. This factual issue remained for
the jury, after the legal establishment of a duty of care. Id. at 609 (finding
that based on the alleged facts, "a trier of fact could conclude that there was
'an imminent probability' that [the student] would try to hurt himself, and
that the defendants had notice of this specific harm"). 85. See American
Academy of Child & Adolescent Psychiatry, Childrens Threats: When Are They
Serious?, http://www.aacap.org/cs/root/facts forfamilies/childrensthreatswhen_ arethey-serious (last visited Apr. 15, 2008);
American Foundation for Suicide Prevention, When You Fear Someone May
Take Their Own Life, http://www.afsp.org/index.cfm?
fuseaction=home.viewPage&page-id=1 (follow "About Suicide" hyperlink,
then follow [91:625 SUICIDE ON CAMPUS and Shin, they appeared to be

highly credible at the time they were made.86 The Supreme Court of Iowa
has nonetheless taken a different view in a similar situation. The court ruled
that the University of Iowa had no special relationship with eighteen-year-old
freshman Sanjay Jain that would trigger a legal duty to take steps to prevent
him from harming himself.87 Sanjay lived in an off-campus university
dormitory.' The hall coordinator, a university administrator, was familiar with
his moodiness and with at least some of his experimentation with alcohol and
drugs: by early November, she had penalized him for an egg-throwing
incident and placed him on one-year disciplinary probation for smoking
marijuana in his room. Shortly before Thanksgiving, on-duty resident
assistants in the dorm were called to intervene when Sanjay and his girlfriend
were arguing loudly in the hall over the keys to his moped, which he had
brought up to his room for purposes of asphyxiating himself with the exhaust
fumes9 The next day, the hall coordinator insisted that he move the moped,
encouraged him to seek out university counseling services, and gave him her
home telephone number to call if he intended to hurt himself.91 He assured
her that he would do so and also said he would talk to his family over
Thanksgiving9 That conversation never took place; instead, Sanjay's contacts
with his family during the holiday were reportedly positive and upbeat.93
Shortly after his return to school, Sanjay carried out his erstwhile foiled
intentions. 4 The facts in Jain are somewhat more ambiguous than those
alleged in Schieszler and Shin. The Iowa Supreme Court's legal analysis,
however, presents the most striking difference. The court recited the general
"no duty to rescue" rule of Restatement (Second) of Torts "What to Do"
hyperlink) (last visited Apr. 15, 2008); National Alliance on Mental Illness,
Teenage Suicide,
http://www.nami.org/Content/ContentGroups/Helplinel/Teenage-Suicide .htm
(last visited Apr. 15, 2008). 86. Ferrum College knew that Michael Frentzel
had self-inflicted bruises on his head days before his suicide and was also
aware of several communications of his intentions to his girlfriend and
another friend. Schieszler, 236 F. Supp. 2d at 609. For the factual
circumstances in Shin, see supra notes 6-11 and accompanying text. 87. Jain
v. State, 617 N.W.2d 293,295 (Iowa 2000). 88. Id. at 295. 89. Id. 90. Id. 91. Id.
92. Id. 93. Id. at 296. 94. Id. 2008] MARQUETTE LAW REVIEW section 314 but
utterly failed to mention section 314A, other than an indirect reference to
exceptions, "usually custodial in nature." 95 The plaintiff, Sanjay's father,
acting in his capacity as administrator of his son's estate, conceded the lack
of any custodial nature to the relationship. He argued that the university's
knowledge of Sanjay's mental condition created a special relationship giving
rise to a duty under Restatement (Second) of Torts section 323, concerning
an actor's voluntary assumption of services to another, which must then be
performed with due care.96 Plaintiff's specific contention was that once the
hall coordinator learned of Sanjay's first suicide threat, she had a duty to
notify the dean of students, who then, according to university policy, would
have contacted Sanjay's parents.' The court was unpersuaded, reasoning that
section 323 applies only if "the defendant's actions increased the risk of harm
to plaintiff relative to the risk that would have existed had the defendant
never provided the services initially., 98 This condition was not met in
Sanjay's case; neither was there any reliance upon the university's behavior
by plaintiff's decedent that would satisfy the requirements of section 323.9 '
Surely the Iowa Supreme Court was correct that section 323 was inapplicable
to the facts of the case, and that appears to have been the only argument
that plaintiff made. While other courts have discussed section 323, in addition

to section 314A, in finding a special relationship between an institution of

higher learning and a student, those cases have dealt with either residential
security' or campus activities sponsored or 95. Id. at 297. 96. Section 323
provides: One who undertakes, gratuitously or for consideration, to render
services to another which he should recognize as necessary for the protection
of the other's person or things, is subject to liability to the other for physical
harm resulting from his failure to exercise reasonable care to perform his
undertaking, if (a) his failure to exercise such care increases the risk of such
harm, or (b) the harm is suffered because of the other's reliance upon the
undertaking. RESTATEMENT (SECOND) OF TORTS 323 (1965). 97. Jain, 617
N.W.2d at 296. 98. Id. at 299. 99. Id. at 299-300. 100. See, e.g., Mullins v.
Pine Manor Coll., 449 N.E.2d 331, 334, 336 (Mass. 1983) (determining liability
for the college was based partly on Restatement (Second) section 323 where
breach of residential security led to abduction and rape of a resident
student). [91:625 SUICIDE ON CAMPUS regulated by the university."' For
policy reasons alone, no court would want to hold, nor should any plaintiff
wish to make an argument suggesting, that a college or university acts at its
peril whenever it institutes counseling and other services for students with
mental health problems. This kind of analysis would confirm the fears
observed by the surprised psychological counselors who noted the earliercited "reluctance on the part of many university officials to know the actual
identity of suicidal students, believing that not knowing will protect the
institution from liability in the event of a student's suicide."' 2 Sound social
policy should encourage institutions of higher learning to make such services
available and to use devices such as the College Screening Project to
sensitize students not only to mental health issues in general, but to dangers
of suicidal ideation (in themselves or others) and suicide threats in particular.
Neither Schieszler nor Shin relies upon section 323 for its rationale. Indeed,
Judge Kiser noted that the plaintiff in Schieszler abandoned a section 323
theory at oral argument.03 The implicit suggestion here is that during the
argument, the judge made clear to the plaintiff's lawyer that section 323 was
not applicable to the case. Rather, both Schieszler and Shin are grounded in
the notion that, under section 314A, a special relationship arises between a
college or university and one of its students when a college official has actual
knowledge that the student is seriously suicidal, thus rendering the infliction
of self-harm a highly foreseeable event. Under those circumstances, the
institution has a duty to take reasonable steps to prevent the foreseeable
harm. The Schieszler opinion specifically suggested that one way this duty
could have been discharged under the circumstances would have been to
notify the family of the student's dire " t the Shins have wondered aloud why
no one took this simple step.'05 One other recent case deserves brief
mention. In the unreported case of Mahoney v. Allegheny College, the parents
of junior Chuck Mahoney sued the school, psychological counselors, and the
dean of students and associate dean of students after their son hanged
himself at 101. See, e.g., Furek v. Univ. of Del., 594 A.2d 506, 520 (Del. 1991)
(determining that Restatement (Second) section 323 addressed the duty of a
college having assumed responsibility to protect fraternity pledges from ritual
hazing). 102. Haas et al., supra note 31, at 1234; supra note 58 and
accompanying text. 103. Schieszler v. Ferrum Coll., 236 F. Supp. 2d 602, 608
(W.D. Va. 2002). 104. Id. at 610. 105. See Sontag, supra note 8, at 58. 2008]
MARQUETTE LAW REVIEW [91:625 his off-campus fraternity house.' 6 In
granting summary judgment dismissing the two deans from the action, Judge
Barry F. Feudale concluded that the facts at hand were more similar to those

in Jain than to either Shin or Schieszler. Specifically, the deans at Allegheny

College lacked the detailed knowledge possessed by defendant
administrators in Shin and Schieszler and had been made aware of any
problem at all only three or four days prior to the student's death.'O The
opinion, a case of first impression in Pennsylvania, manifests the judge's
dubiety with respect to the "special relationship" reasoning of the
Massachusetts and Virginia courts,' but it is obviously nonprecedential." B.
FERPA: Not a Valid Defense Now... Time after time, when students take their
own lives, the parents' agonizing cry is, "Why were we not told that our child
was so desperate?" That omission underlay the case against the MIT
administrators in the Shins' lawsuit;.' it was one of the steps cited by the
judge that Ferrum College might have taken to help protect Michael
Frentzel;"' and it was the chief bone of contention asserted by Uttam Jain,
Sanjay's father and administrator of his estate." 3 Chuck 106. Mahoney v.
Allegheny Coll., No. AD 892-2003, slip. op. at 1-2 (C.P. Crawford C
ty, Pa. Dec. 22, 2005). 107. Id. at 23 (stating, after examination of all three
cases, "The MIT and Ferrum cases are factually distinctive ... . 108. Id. at 22.
109. Id. at 23 ("The appellation/determination of 'special relationship' outside
the context of custody and/or control is subjective in nature and could be
construed as an elevation of form over substance that could lend itself to
reactive rather than reflective results steeped in 'hindsight' as compared to a
careful and precise legal analysis required in a duty of due care."). 110. The
case subsequently went to trial against the campus counselor who had
worked with Chuck Mahoney, Allegheny College as her employer, and a
psychiatrist who prescribed the student's medications. The jury returned a
verdict eleven to one in favor of defendants; the jurors based their vote on
Mr. Mahoney's status as an adult and on skepticism as to the parents'
ignorance of the seriousness of his mental state. The lone dissenter, a retired
high school teacher, stated her belief that "'safety must trump privacy."' See
Bernstein, supra note 19. 111. See Complaint 72, Shin v. MIT, No. 02-0403
(Mass. Super. Jan. 28, 2002) ("Defendants... acted in a wilful, wanton,
reckless, or grossly negligent manner, by failing to design and implement an
adequate mental health protocol, including . . . parental involvement, in the
treatment of Elizabeth Shin."); see also Sontag, supra note 8, at 140 (quoting
Cho Hyun Shin: "If they just let us know, just the one phone call, [Elizabeth]
would be alive right now."). 112. Schieszler v. Ferrum Coll., 236 F. Supp. 2d
602, 610 (W.D. Va. 2002). 113. Jain v. State, 617 N.W.2d 293, 296-99 (Iowa
2000). SUICIDE ON CAMPUS Mahoney's parents also maintained that
Allegheny College should have broken confidentiality and involved them. "4
Behind the plaintiffs' query is the thinking that if only they had known, they
could and would have done something to defuse the precipitate situationwithdraw the son or daughter from school, perhaps, or at least take steps to
assure themselves that the crisis was past and the underlying problems were
being dealt with effectively. Whether or not they are right is unknowable, but
that question will haunt them for the rest of their lives. They should not have
to live with it. The universal response on the part of the schools, of course, is
that in loco parentis is a thing of the past: Schools have no responsibility to
supervise their students and no right to intervene in their lives. "5 College
students are almost universally above the age of eighteen and therefore legal
adults. Furthermore, the best way to assist their maturation is to treat them
as independent, autonomous individuals, responsible for their own welfare."6
In addition to these general contentions, all of which-at least in the abstract-

are true, educational institutions point to the Family Educational Rights and
Privacy Act ("FERPA"), also known as the Buckley Amendment."7 These 1974
amendments to the Elementary and Secondary Education Act of 196518
condition federal funding "to educational agencies or institutions"'' 9 upon
compliance with provisions regulating first, the availability of school records
to parents and students,'2 and second, the privacy of those records vis-A-vis
the rest of the world. With respect to college students, the provisions relevant
to 114. See Mahoney v. Allegheny Coll., No. AD 892-2003, slip op. at 18-19
(C.P. Crawford County, Pa. Dec. 22, 2005). 115. See, e.g., Schieszler, 236 F.
Supp. 2d at 611 (noting defendant's argument that school had no duty
because "they had insufficient custody or control of [suicidal student]");
Mahoney, slip op. at 18-19, 23; see also Bernstein, supra note 19 (discussing
privacy laws vis-Avis whether an educational institution should involve
parents). 116. Baldwin v. Zoradi, 176 Cal. Rptr. 809, 818 (Cal. Ct. App. 1981)
("The transfer of prerogatives and rights from college administrators to the
students is salubrious when seen in the context of a proper goal of
postsecondary education-the maturation of the students. Only by giving them
responsibilities can students grow into responsible adulthood .... [T]he overall
policy of stimulating student growth is in the public interest."); see also
Bernstein, supra note 19 (noting that jury ruled for defendants because it
considered Chuck Mahoney an adult, "responsible for his own actions."). 117.
20 U.S.C. 1232g (2000 & Supp. V 2005). The bill was sponsored by Sen.
James L. Buckley of New York. 118. Pub. L. No. 93-380 (1974). 119. 20 U.S.C.
1232g(a). 120. See 20 U.S.C. 1232g(a)(1)-(6). 2008] MARQUETTE LAW
REVIEW the issue at hand protect the privacy of the records of any student
over the age of eighteen years from anyone else, including the student's
parents, absent the student's consent."' Some of the bizarre results, in the
eyes of most parents who have put a child through college,12 ' are that all
tuition and other financial statements are sent to the student, not to the
parents who are actually paying, and grades are also addressed to the
student only-parents have no right to find out what they are unless the
student chooses to divulge the information. Similarly, parents may be
blissfully unaware that a child is on academic or disciplinary probation, or is
otherwise encountering any kind of problem in his or her collegiate life. 13
FERPA has some exceptions, however. The important one for present
purposes provides that an educational institution may disclose personal
information to "appropriate persons" "in connection with an emergency ...if
the knowledge of such information is necessary to protect the health or
safety of the student or other persons."24 Information that a student is
seriously suicidal or has attempted suicide easily fits the definition of an
"emergency"; the student's parents or guardian would in almost any
conceivable case be "appropriate persons" to notify; and conveyance of the
information is logically "necessary to protect the health or safety of the
student.' , 12 1 This argument was raised by the plaintiff in Jain v. State.12
Indeed, 121. See 20 U.S.C. 1232g(d). 122. These comments are anecdotal
in nature. They reflect the experiences and attitudes of my husband and
myself, as well as a number of our contemporaries with whom we have
discussed the situation. In our experience, it is not uncommon to hear a
parent say something like, "You mean I am paying for this and have no right
to find out anything about what is going on?" At the same time, we who work
for educational institutions are aware that their administrations can be almost
paranoid about the necessity of compliance with the "Buckley Amendment."
123. For example, Sanjay Jain (who had turned eighteen just prior to his

freshman year) had been skipping numerous classes and was doing poorly
academically. He had also been placed on disciplinary probation, one
condition of which was an order to attend alcohol and drug education classes,
after he was found smoking marijuana in his room. Jain v. State, 617 N.W.2d
293, 295 (Iowa 2000). This observation is not intended as an argument for a
return to in loco parentis; it is offered simply as an example of parental
ignorance of what goes on with their students on campuses today. 124. 20
U.S.C. 1232g(b)(1)(I) (2000 & Supp. V 2005). The accompanying regulation
provides: "An educational agency or institution may disclose personally
identifiable information from an education record to appropriate parties in
connection with an emergency if knowledge of the information is necessary
to protect the health or safety of the student or other individuals." 34 C.F.R.
99.36(a) (2006). 125. Id. 126. Jain v. State, 617 N.W.2d 293, 298 (Iowa 2000).
[91:625 SUICIDE ON CAMPUS the University of Iowa had an unwritten policy
of notifying parents of any student suicide attempt, although that decision lay
solely in the hands of the dean of students. The dean, however, had never
received the information. 2'7 The problem with the plaintiff's argument here,
as the Iowa Supreme Court pointed out, was that FERPA's exception is
discretionary in nature. While it permits a school to contact the student's
family in the circumstances of attempted suicide, it does not create any duty
on the school's part to do So.2 In fact, the relevant regulations stipulate that
FERPA's exception for disclosure of health and safety information shall be
"strictly construed.', 29 Once again, the Jain court was correct. The federal
statute does not impose any duty of notification of family on a collegiate
institution that has actual knowledge of a suicidal student. It merely permits
such notification. The argument of this Article is simply that institutions of
higher learning should not be permitted to "hide behind" FERPA as a defense
for their failure to contact families in such circumstances. Frequently, that
simple act might be sufficient to discharge the institution's duty of care,
which, this Article argues, arises from the institution's actual knowledge,
which in turn creates the foreseeability of the student's self-infliction of harm.
The missed opportunity in Jain is especially poignant, given that the suicide
attempt took place on November 20, very shortly before the Thanksgiving
break, and the actual suicide occurred on December 4, very shortly
afterwards.3 Although Sanjay refused the hall coordinator's request for
permission to call his parents, he told her that he would discuss his situation
with them over the break;'3' his assurance turned out to be untrustworthy.
Similarly, Chuck Mahoney had spoken to his parents the Saturday before his
suicide. In response to a specific question posed by his counselor on the very
day he hanged himself, he assured her that he "had told them all that was
going on," although he also asked her not to contact them.32 He had written
the counselor a 127. Id. at 296. 128. Id. at 298; see also Mahoney v.
Allegheny Coll., No. AD 892-2003, slip op. at 18 (C.P. Crawford County, Pa.
Dec. 22, 2005). 129. Jain, 617 N.W.2d at 298 (quoting 34 C.F.R. 99.36(c)
(1994), the administrative regulations for implementing the Buckley
Amendment). 130. Id. at 295-96. 131. As university protocol required, the hall
coordinator relayed the information to her supervisor, the associate dean of
students. He agreed with her recommendation to Sanjay to seek counseling;
however, he took no further steps and did not notify the dean of students,
who might have contacted Sanjay's parents. Id. 132. Mahoney, No. AD 8922003, slip op. at 10. 2008] MARQUETTE LAW REVIEW desperate-sounding
email at 3:18 that morning, but she felt it necessary to abide by his wishes.'
She and the associate dean of students, in a conversation later that same

day, discussed the fact that, while she felt bound by the therapist-patient
relationship not to make parental contact,'3 4 the associate dean need not
have such concerns. The counselor and Chuck had another meeting
scheduled for the next day, so the associate dean decided to do nothing. In
Schieszler, the dean of students at Ferrum College had obtained a written
statement from Michael Frentzel that he would not harm himself. Yet
Michael's frantic communications to friends within the next few days belied
that statement,36 and, though warned, the college failed to follow up before
Michael hanged himself.137 Elizabeth Shin, it will be remembered, celebrated
her nineteenth birthday with her family only a day before what certainly
appears to have been the taking of her own life. 138 On that occasion, she
talked about obtaining passport photos for a planned summer trip to Korea
and invited her younger sister to visit her for a weekend.'39 She had held a
knife to her chest only the night before, as her housemaster knew.4 Yet
Elizabeth's parents had no clue, and her behavior at the dinner gave nothing
away about the sense of desperation she must have been feeling. All four
schools involved in these tragic situations have defended their failure to
notify students' families of their children's problems on the grounds of respect
for student privacy.'41 133. Id. at 8-10. 134. Id. at 13. The therapist would
have had in mind the Health Insurance Portability and Accountability Act of
1996 and the privacy regulations thereunder, which heavily restrict a
healthcare provider's sharing of information without the patient's permission.
Pub. L. No. 104-191, 110 Stat. 1936 (codified as amended in scattered
sections of 18, 26, and 42 of U.S.C.). See generally 45 C.F.R. 164.500-.534
(2007). This paper takes no position with respect to the potential liability of
healthcare providers in the situations under discussion, which would be
governed by principles of medical malpractice law. 135. Mahoney, No. AD
892-2003, slip op. at 13. 136. Schieszler v. Ferrum Coll., 236 F. Supp. 2d 602,
605 (W.D. Va. 2002) (Within a few days of signing the statement for the dean,
Michael wrote to a friend, "'tell Crystal I will always love her.' The friend told
Crystal who told the defendants .... Soon thereafter, Frentzel wrote yet
another note stating 'only God can help me now,' which Crystal pressed upon
the defendants."). 137. Id. 138. See supra notes 8-11 and accompanying text.
139. Sontag, supra note 8, at 58. 140. Complaint, supra note 9, $J 33-35. 141.
See, e.g., Jain v. State, 617 N.W.2d 293, 295 (Iowa 2000) ("Sanjay's parents
and family were unaware of [his academic and personal] difficulties [at the
University of Iowa]. University policy calls for privacy with respect to the
university's relationships with its adult students."); Sontag, supra note 8, at
94 ("M.I.T., like many schools, operates from the premise [91:625 SUICIDE ON
CAMPUS That general attitude is perfectly appropriate and, indeed, is
required for compliance with federal funding statutes. Yet taken to its logical
conclusion, it sends a message of callous indifference-an inappropriate
"hands off" mentality-to grieving families who have learned that the
expensive and prestigious educational institutions to which they were
sending their children knew those children were in dire straits but failed to
notify the families, who were clearly deeply involved in the welfare of their
young members. Respect for student privacy as a defense, even buttressed
by a federal law, fails to honor that law's exception and is no excuse for the
schools' failure to take every reasonable step, including, but not limited to,
family notification, to avert these young deaths. C. ... But the Proposed
Amendment Would Offer Valuable Clarification In the wake of the events at
Virginia Tech, and in the face of obvious institutional confusion with respect to
the reach of FERPA's emergency exception, U.S. Representative Tim Murphy

of Upper St. Clair, Pennsylvania, introduced into Congress a bill to amend

FERPA to make it clear that colleges and universities indeed have the right to
notify a dependent student's parents (even when the student is beyond
eighteen years of age) when the student appears to pose a danger of
violence to self or others.'42 Representative Murphy, an experienced child
psychologist, was motivated in part by Chuck Mahoney's suicide. He
characterized the current exception as "too vague" and noted that
educational institutions today are "'concerned that they'll end up with legal
problems. We want them to first be thinking of student safety.""43 Shortly
after its introduction, the bill was soundly endorsed by a number of major
universities. Said Robert Berdahl, president of the Association of American
Universities, representing sixty-two universities in the United States and
Canada, "'We're pleased that he's seen the need for change .... This will give
greater latitude to presidents and chancellors to contact parents. ' 44 The
proposed "Mental Health Security for America's Families in Education Act of
2007"' 5 begins with a series of findings concerning the prevalence of mental
illness among young adults, focusing especially on not that parents have a
right to know but that students are adults with a right to privacy and a
responsibility for self-care."). 142. See Sherman, supra note 29. 143. Id.
(quoting Rep. Tim Murphy). 144. Id. (quoting Robert Berdahl). 145. H.R. 2220,
110th Cong. (as referred to House Committee on Education and Labor, May 8,
2007). 2008] MARQUETTE LAW REVIEW college students.'" While noting the
importance of confidentiality,'47 the proposed amendment also finds that
"[p]arents and legal guardians of a student may be in the best position to
supply essential help to a student suffering from significant mental illness,"
and "the value of parental involvement should not end when a student has
attained 18 years of age."',18 Most specifically, the findings quote the FERPA
exception in its entirety and make the following point: The unintended
consequence of FERPA . . .is that school personnel, administrators, and
teachers who have little or no training in mental health and mental illness are
burdened with defining and determining if a student is at risk. These
educational personnel are reluctant to release information to parents for fear
of legal action. These issues create barriers and delays for informing families
even when schools are concerned that students may be a risk to themselves
or others. Section 3 of the bill, entitled "Mental Health Disclosures for Student
Safety," provides that an educational agency or institution of higher
education may disclose, to a parent or legal guardian of a student who is a
dependent (as defined in section 152 of the Internal Revenue Code of 1986),
information related to any conduct of, or expression by, such student that
demonstrates that the student poses a significant risk of harm to himself or
herself, or to others, including a significant risk of suicide, homicide, or
assault. 5 The disclosure permission is limited to situations in which college
personnel obtain written certification from a licensed mental health
professional, approved by the state where the institution is located, certifying
(1) that the professional has reason to believe that the student's conduct or
expression in fact demonstrates a significant risk of harm to self or others
and (2) that the possession of such information by 146. Id. 2(1)-(5). 147. Id.
2(7). 148. Id. 2(9), (10). 149. Id. 2(11). 150. Id. 3(k)(1). [91:625
SUICIDE ON CAMPUS the student's parent or legal guardian might protect the
health or safety of the student or others.'1 Importantly, the bill does not
require that the mental health professional has actually seen the student;
consultation between the college administration and the professional, as a
safeguard to validate the administrator's own evaluation, is presumably all

that is necessary. Representative Murphy's proposed amendment is a

laudable and needed correction to the overreaction to FERPA on the part of
many educational institutions and their concomitant hesitation to notify the
families of troubled students under the current exception.' 2 Like that
exception, however, the bill only permits, but does not require, that such
notification take place. One would like to think that Elizabeth Shin, Michael
Frentzel, Sanjay Jain, and Chuck Mahoney, along with others, would still be
alive today if that amendment had been in place. At least, the families might
have been brought into the respective situations to try to see that the best
possible care was undertaken. But even if Congress does its part by passing
this amendment, tort law should recognize an actual duty on the part of
educational institutions to notify parents or guardians of students who exhibit
credible suicidal threats. IV. THE ARGUMENT FROM PSYCHOLOGY Although we
have fixed the age of legal adulthood at eighteen and institutions of higher
learning frequently cite that, along with FERPA, as key to their noninterventionist stance towards their students,"' a burgeoning body of
psychological literature tells us that a substantial number of young people in
the age bracket of undergraduate students are highly susceptible to the kinds
of mental health issues that can lead to suicidal ideation and actual attempts.
Moreover, ongoing research 151. Id. 3(k)(2). 152. Dr. Robert Berdahl,
president of the Association of American Universities and former chancellor at
the University of California, Berkeley, has stated that "he has known of cases
in which college officials were reluctant to act because of legal issues."
Sherman, supra note 29. 153. See, e.g., Bradshaw v. Rawlings, 612 F.2d 135,
139 (3d Cir. 1979) (noting, in agreement with defendant's argument, that
"[c]ollege students today are no longer minors; they are now regarded as
adults in almost every phase of community life"); accord Beach v. Univ. of
Utah, 726 P.2d 413, 418-19 (Utah 1986) (quoting Bradshaw); Furek v. Univ. of
Del., 594 A.2d 506, 516-17 (Del. 1991) (quoting Bradshaw); see also Jain v.
State, 617 N.W.2d 293, 295 (Iowa 2000) (noting that "University [of Iowa]
policy calls for privacy with respect to the university's relationships with its
adult students"); Bernstein, supra note 19 (noting Allegheny College's
argument that Chuck Mahoney was an adult and it would have violated his
privacy for the school to contact his parents against his request). 20081
MARQUETTE LAW REVIEW into brain development, revealing later
development in the cerebral cortex than scientists had once thought to be
the case, might correlate with lower faculties of judgment and impulse control
than can be expected in more mature adults. A. Mental Health Issues on
Campus Nationally, college student suicide is such a sufficiently pressing
problem that in 2002, the National Mental Health Association and The Jed
Foundation co-sponsored a panel of thirty leading experts from various
disciplines1" to convene for a conference entitled, "Expanding the Safety Net:
A Roundtable on Vulnerability, Depressive Symptoms, and Suicidal Behavior
on College Campuses" ("College Suicide Conference"). The panel focused on
full-time students, aged eighteen to twenty-four, living in or near the
campuses where they attended school. The panel found that "two distinct
groups of students" are at higher risk for suicide: those with "pre-existing
mental health conditions" at the time they enter college and those who
"develop mental health problems during the college years. ' With respect to
the first group, the panel emphasized that college counseling services could
not provide the total support that these students need. Rather, "college
administrators and counselors must work more closely with the students,
their families, their previous school systems, and other healthcare providers

in order to ensure a more successful transfer of care."1'56 This suggestion of

a network of communication is a far cry from the "hands off" attitude that
appears to prevail on so many campuses. Further, warned the panel, the
"nature of the campus environment itself may serve to exacerbate any
existing [conditions]," and "schools should try to avoid a cold, impersonal
atmosphere where students feel they are treated as 'just a number.' This type
of environment may only serve to unwittingly aggravate any feelings of
inadequacy and lack of self worth. ,157 Other studies reveal that the number
of students arriving on campuses in this first group-students with pre-existing
mental health problems-has grown tremendously in recent years. The
development 154. These included "clinical psychology, developmental
psychology, and psychiatry, as well as epidemiology, suicidology, sociology,
and public health." NMHA & JED FOUND., supra note 34, at 2. 155. Id. at 5.
156. Id. 157. Id. [91:625 SUICIDE ON CAMPUS of new drugs, notably antidepressants such as Prozac and Zoloft, along with Ritalin, has enabled
numbers of students to go to college who in times past would have been too
sick to handle collegiate life.15 Time magazine, in its January 2001 article on
the subject, quoted well-known Johns Hopkins psychologist Kay Redfield
Jamison: "The very effectiveness of modern treatment means that a lot of
people who never would have made it into college are stable enough to go to
universities .... [Colleges] are dealing with a lot of kids who are very sick.' 159
Besides the students who arrive at college with existing mental health
problems, large numbers of students develop emotional difficulties or even
full-blown psychological disorders while they are there. One report states that
"[i]n 2001, 85% of North America's student counseling centers reported an
increase in 'students with severe psychological problems' over the past five
years. Thirty percent of them had a student suicide . . . ."'60 Hospitalizations
are also up: eighty-nine percent of campus counseling centers sent at least
one student to the hospital in 2001.61 According to psychiatrist Morton
Silverman, head of counseling services at the University of Chicago,
counselors are diagnosing many more cases of depression than they once
did.162 The American Foundation for Suicide Prevention has found that
"depression is the most prevalent diagnosis among young people who
commit or attempt suicide. ' '16 ' This group also reported on studies
attributing "more than 90% of all suicides [among youth and adults,
generally] at least partly to a psychiatric disorder, most commonly a mood
disorder." 16 4 Strikingly, a number of such disorders characteristically
emerge for the first time during the late teens or early twenties. One report
states: There is the indisputable fact that age 18 to 25 is prime 158. Haas et
al., supra note 31, at 1229 (also noting that the Americans with Disabilities
Act has contributed to this effect); Kelly, supra note 32, at 52; accord, Ellen,
supra note 37, at 5; Marano, supra note 52. 159. Kelly, supra note 32, at 52
(alteration in original). Kay Redfield Jamison, herself afflicted with bipolar
disorder, is the author of such highly respected books as An Unquiet Mind: A
Memoir of Moods and Madness (autobiographical) and Night Falls Fast:
Understanding Suicide. She was also a member of the 2002 expert panel
assembled to discuss the crisis of suicide on campus. See supra notes 34 and
154 and accompanying text. 160. Marano, supra note 52. 161. Id. 162. Id.
163. Haas et al., supra note 31, at 1232. 164. Id. at 1228. 2008] MARQUETTE
LAW REVIEW [91:625 time for eruption of mental illness, making college, with
its concentration of 18- to 25-year-olds, the prime place. Increasingly, mental
health professionals recognize that depression, anxiety disorders, bipolar
illness, personality disorders and schizophrenia are conditions that first arise

in young adulthood. Catching them quickly is critical, as early management

strongly influences how they play out over adulthood.65 These data suggest
that, although it is tempting to think that parents who fail to detect their
children's symptoms must be turning a blind eye to the obvious, such may
not be the case at all.' 66 A number of factors can exacerbate mental health
problems once students reach the campus. 167 Many students coming to
college are away from home for the first time, "entering into a new, unknown
environment that may be extremely different from that with which they are
familiar, and these are significant developmental issues."'16 Students who
were successful in high school may encounter academic difficulties for the
first time. 69 165. Marano, supra note 52; accord Ellen, supra note 37, at 4
("Severe psychiatric disorders such as bipolar disorder and schizophrenia
typically first manifest themselves between the ages of 18 and 24 years and
can easily derail the lives of students."); Kelly, supra note 32, at 52 ("[M]any
of the major psychiatric illnesses, including depression, bipolar disorder and
schizophrenia, often do not manifest themselves until the late teens or early
20s."). 166. See, e.g., Sontag, supra note 8, at 57, 58 (noting that the last
time the Shins saw Elizabeth, she "seemed like herself"; now "[t]hey suspect
that people wonder about them.... 'Some people might ask, "How could you
not see?"' Cho Hyun Shin, [Elizabeth's] father, says"). Sanjay Jain's telephone
calls home were described as "upbeat," and he appeared perfectly normal to
his family over the Thanksgiving break immediately after his suicide attempt.
Jain v. State, 617 N.W.2d 293, 295, 296 (Iowa 2000). In a similar vein, a
stepfather interviewed on CBS's Early Show spoke of his stepson who
committed suicide after losing his place on the Western Kentucky basketball
team on account of a foot injury: "We're not realizing that because he couldn't
play, because he wasn't achieving, in his mind that he wasn't measuring up.
So all of a sudden, he's sinking. Right before everybody's eyes, he's sinking,
and we don't even see him sinking." The Early Show: Suicide on Campus (CBS
television broadcast Nov. 8, 2004), transcript available at
http://www.cbsnews.com/
stories/2004/11/07/earlyshow/contributorsftracysmithlmain654130.shtml.
167. Marano, supra note 52. 168. NMHA & THE JED FOUND., supra note 34, at
5. 169. Both Elizabeth Shin and Sanjay Jain fell into this category. Elizabeth,
who was salutatorian of her high school class, began to "panic about
academic success" her freshman year at MIT and "saw it as a failure [that]
she did not pass physics in her first term." Sontag, supra note 8, at 60, 61.
Likewise, Sanjay was academically successful in high school, but in college
quickly found that his chosen field of biomedical engineering seemed too
difficult. Jain, 617 N.W.2d at 295. One expert points to "academic failure" as
"frequently linked to suicidal behavior and completed attempts." Ellen, supra
note 38, at 7. SUICIDE ON CAMPUS Added to the academic stressors are the
typical patterns of college life. Said Time magazine in 2001, "College can be a
breeding ground for psychiatric problems. Poor eating habits, irregular
sleeping patterns and experimentation with drugs and alcohol" can all
contribute to mental health problems.'70 The panel of thirty experts at the
2002 College Suicide Conference agreed and pointed additionally to social
and financial stress.' These observations have been borne out in student
surveys. According to one survey of college freshmen conducted by UCLA in
1999, "a record 30.2% (39% of women and 20% of men) frequently felt
overwhelmed by what they had to do.' 72 This survey, conducted annually
since 1966, has found "rising stress levels since 1985, when 16% said they
were overwhelmed.' 73 Another survey found that "76% of students felt

'overwhelmed' [in 2001] and 22% were sometimes so depressed they could
not function.' 174 The picture that emerges is one of young people in
transition, no longer children but nonetheless sometimes confused and even
overwhelmed by the experiences they face in college. Gary Pavela, a noted
authority on academic ethics and student rights and responsibilities, has
commented on this phenomenon. Writing for The Chronicle of Higher
Education in 1992, he had this to say: I think that it is time to give a new
name to college students who are between the ages of 18 and 21. The term
"adolescents" does not do them justice, yet calling them "young adults"
suggests a level of maturity that many do not possess. Instead, I suggest
calling them "post-adolescent pre-adults," or PAPAS, for short. 170. Kelly,
supra note 32, at 52; see also Marano, supra note 52 ("Many students fall
apart given the looser environment, erratic sleeping patterns and added
stresses of college."). 171. NMHA & JED FOUND., supra note 34, at 10. 172.
Haas et al., supra note 31, at 1228. The survey, conducted in September
1999 and reported by the UCLA Higher Education Research Institute in 2002,
covered more than 350,000 freshmen at 683 colleges and was "statistically
adjusted to reflect 1.5 million firsttime, full-time students nationwide." Id.
173. Id. 174. Id. This report came from the American College Health
Association's National College Assessment. Id. 175. Gary Pavela, Today's
College Students Need Both Freedom and Structure, CHRON. HIGHER EDUC.
(Wash. D.C.), July 29, 1992, at B1. Professor Pavela is the Director of Judicial
Programs at the University of Maryland-College Park and editor of the
national quarterly, Synthesis: Law and Policy in Higher Education, as well as
the related Synfax Weekly Report. 2008] MARQUETTE LAW REVIEW Professor
Pavela's article urges institutions of higher learning to re-think their
obligations to provide for their students the appropriate environment to meet
their needs as they mature into adulthood. He cites with approval the
Delaware Supreme Court's ruling in Furek v. University of Delaware, finding
that the university had a duty of care "to regulate and supervise foreseeable
dangerous activities occurring on its property"-specifically, in the context of a
fraternity hazing incident on university-owned land.'77 Like that court,
Professor Pavela thinks that a "special relationship" exists between a
university and its resident students, at least paralleling the situation of
landowner/business invitee .17 178 While psychology experts do not use
Pavela's terminology, their findings and recommendations reflect the same
line of thinking. The panel of experts at the College Suicide Conference
recommends a "multifaceted collaborative approach" to the situation that
goes beyond counseling centers to include administrators and the rest of the
university community, including faculty, coaches, clergy, and student or
resident advisors, as well as the general student body.179 All of these people
should be educated about the problem, and university personnel should be
trained to spot risky behaviors (such as alcohol and drug abuse) that might
mark a potentially suicidal student. Students should be informed as well, as
"[t]hey are often more adept at noticing changes and detecting trouble in
their peers than are many professionals who may merely be casual
observers."'" Student support groups can often provide a non-threatening
outlet for conversation, and stress-reduction programs can be quite helpful.'
The panel also advises colleges and universities to make parents and families
aware of their services, and especially recommends coordination where
students already have a history of mental health problems.1 The College
Screening Project, discussed above,"' was developed by the American
Foundation for Suicide Prevention as a 176. 594 A.2d 506 (Del. 1991); see

supra notes 72-73 and 76-77 and accompanying text. 177. Pavela, supra note
175. 178. See id. 179. NMHA & JED FOUND., supra note 34, at 8-9. 180. Id. at
9. 181. Id. at 10. 182. Id. at 9. See also id. at 12 (Table 6, "A Checklist for Your
Institution," asks, inter alia, "Do we have a transitional support program in
place for parents and families of incoming students who have already been
diagnosed with mental health disorders?"). 183. See supra notes 43-49 and
accompanying text. [91:625 2008] SUICIDE ON CAMPUS result of the same
kind of response to the problem." These suggestions for open institutional
approaches recognize both the transitional nature of this highly vulnerable
time of life and the need for programs on campuses that can nurture their
students and provide the emotional support that all of them-not just those
with specific mental health problems-need in order to thrive."' B. Brain
Development Studies: A New Avenue to Behavioral Research Recent studies
in brain development may contain clues to psychological maturation and agerelated behaviors that have yet to be explored. Only in the past few years,
with the advent of magnetic resonance imaging devices ("MRIs"), have
neuroscientists been able safely to conduct longitudinal studies on the brains
of healthy children as they progress through normal developmental
stages.186 The leading team of experts in these efforts has been headed by
Dr. Jay Giedd, chief of brain imaging in the child psychiatry branch at the
National Institute of Mental Health ("NIMH"). He and colleagues at NIMH,
along with a group from UCLA, have painstakingly analyzed MRIs taken every
two years of children from ages four to twenty-one.8 These researchers and
others conducting similar or parallel work' have learned, to their 184. See
generally Ellen, supra note 38; Ellen, supra note 37; Haas et al., supra note
31; see also supra notes 43-49 and accompanying text (discussing the
College Screening Project). 185. The pressures of college life, including
leaving home, being on one's own, academic stress, etc., affect all students,
as experts in psychology recognize. See supra notes 167-75 and
accompanying text (discussing stresses encountered in college). 186. See,
e.g., Claudia Wallis, What Makes Teens Tick, TIME, May 10, 2004, at 56, 59
(quoting Dr. Jay Giedd, that MRI technology "'made studying healthy kids
possible' because there's no radiation involved," and also noting that
"[b]efore MRI, brain development was studied mostly by using cadavers").
187. See generally Jay N. Giedd, et al., Brain Development During Childhood
and Adolescence: A Longitudinal MRI Study, 2 NATURE NEUROSCIENCE 861
(1999); Nitin Gogtay et al., Dynamic Mapping of Human Cortical Development
During Childhood Through Early Adulthood, 101 PROCEEDINGS OF THE NAT'L
ACAD. OF SCI. OF THE U.S.A. 8174 (2004); Nat'l Inst. of Mental Health,
Teenage Brain: A Work in Progress (2004) [hereinafter NIMH, Teenage Brain],
available at http://www.nimh.nih.gov/publicat/ teenbrain.cfm; Wallis, supra
note 186; Frontline, Inside the Teenage Brain (PBS television broadcast Jan.
31, 2002), transcript available at http://www.pbs.org/wgbh/pages/frontline/
shows/teenbrain/etc/synopsis.html; Press Release, Nat'l Inst. of Mental Health,
Imaging Study Shows Brain Maturing (May 17, 2004) [hereinafter NIMH,
Imaging Study], available at
http://www.nimh.nih.gov/press/prbrainmaturing.cfm. 188. For example, using
functional MRI, ("fMRI"), Dr. Deborah Yurgelun-Todd, of Harvard's McLean
Hospital, has studied brain activity of teens and adults as they identified
emotions on pictures of faces. There was a striking difference in the abilities
of the two groups to identify fear: 100% of adults identified it correctly, while
only about half of the teenagers did so. Frontline, supra note 187 (follow
"Work in Progress" hyperlink, then follow MARQUETTE LAW REVIEW [91:625

surprise, that a number of structural changes occur in the brain much later in
adolescence than anyone had supposed. Until these studies, most scientists
believed that the brain had completed its development by around the age of
twelve. 89 They know now that at about age eleven in girls and age twelve in
boys, there is a second wave of synapse formation and a spurt of growth in
the cerebral cortex, followed by a "pruning back" throughout adolescence.' 9
(The first such outburst of activity takes place in early childhood. 91 ) While
the pruning process means a loss of gray matter (the "thinking" part of the
brain),"9 it also consolidates learning, by discarding weaker branches and
connections. At the same time, the brain wraps myelin, the white matter of
the brain, around other connections to strengthen and stabilize them.9
Myelinization actually goes on until a person's fourth decade.'94 While the
exact ages at which this brain activity occurs may differ from one person to
another, there is a consistent developmental pattern.95 Many parts of the
brain undergo developmental change during the teen years,'96 although
most striking is the growth of the "Interview: Deborah Yurgelun-Todd"
hyperlink) (interview with Deborah Yurgelun-Todd, in which she reports that
teens tended to interpret the fearful facial expressions as "sadness" or
"confusion"). 189. Wallis, supra note 186, at 56. 190. Frontline, supra note
187 (follow "Work in Progress" hyperlink, then follow "Adolescent Brains are
Works in Progress" hyperlink) (producer Sarah Spinks describing why
"Adolescent Brains are Works in Progress"). 191. NIMH, Teenage Brain, supra
note 187 ("Prior to this study, research had shown that the brain
overproduced gray matter for a brief period in early development-in the
womb and for about the first 18 months of life-and then underwent just one
bout of pruning."); NIMH, Imaging Study, supra note 187 ("It was long
believed that a spurt of overproduction of gray matter during the first 18
months of life was followed by a steady decline as unused circuitry is
discarded."); Frontline, supra note 187 (follow "Work in Progress" hyperlink,
then follow "Adolescent Brains are Works in Progress" hyperlink) (Sarah
Spinks, reporting that "[i]t was thought at one time that the foundation of the
brain's architecture was laid down by the time a child is five or six"); see
supra note 187 (follow "Work in Progress" hyperlink, then follow "Interview:
Jay Giedd" hyperlink) (Dr. Jay Giedd, in an interview, stating that "[b]y age
six, the brain is already 95 percent of its adult size"). 192. See, e.g., Frontline,
supra note 187 (follow "Work in Progress" hyperlink, then follow "Interview:
Jay Giedd" hyperlink). 193. Frontline, supra note 187 (follow "Work in
Progress" hyperlink, then follow "Adolescent Brains are Works in Progress"
hyperlink). 194. Gogtay et al., supra note 187, at 8178. 195. NIMH, Teenage
Brain, supra note 187. 196. Gogtay et al., supra note 187, at 8175-78;
Frontline, supra note 187 (follow "part of the brain" hyperlink). Both of these
sources show diagrams of the teenage brain; Gogtay et al. have used timelapse sequences to make a "movie" of pediatric brain development. SUICIDE
ON CAMPUS prefrontal cortex, which is the latest part of the brain to
mature.9'7 The timing is important because that is the area responsible for
the brain's highest judgmental faculties. Scientists call it the site of the
"'executive functions'-planning, impulse control and reasoning. ' ' 98 In an
interview, Dr. Giedd stated: The frontal lobe is often called the CEO, or the
executive of the brain. It's involved in things like planning and strategizing
and organizing, initiating attention and stopping and starting and shifting
attention. It's a part of the brain that most separates man from beast, if you
will. That is the part of the brain that has changed most in our human
evolution, and a part of the brain that allows us to conduct philosophy and to

think about thinking and to think about our place in the universe. ' 99
Researchers are uncertain as to how long the brain's maturation process goes
on, but they believe that it continues into young adulthood, at least through
the early twenties. Says Dr. Giedd, "When we started, . . we thought we'd
follow kids until about 18 or 20. If we had to pick a number now, we'd
probably go to age 25."2 00 The question, of course, is what this newfound
knowledge tells us about behavior, generally, and mental health issues, in
particular, in the teens and early twenties. Scientists so far are cautious in
stating the Gogtay et. al., supra note 187, at 8174. 197. Gogtay et al., supra
note 187, at 8176-77. Researchers may also refer to the lastdeveloping area
as the "temporal cortex," the "temporal lobe," or the "frontal lobe." See, e.g.,
id. (using various terms); Frontline, supra note 187 (follow "Work in Progress"
hyperlink, then follow "Adolescent Brains are Works in Progress" hyperlink)
("prefrontal cortex" or "frontal lobe"); Wallis, supra note 186, at 61
("prefrontal cortex"). 198. NIMH, Teenage Brain, supra note 187; Wallis, supra
note 186, at 61 ("planning, setting priorities, organizing thoughts,
suppressing impulses, weighing the consequences of one's actions"); NIMH,
Imaging Study, supra note 187 (naming as examples of "executive functions"
"integrating information from the senses, reasoning, and other[s]"). 199.
Frontline, supra note 187 (follow "Work in Progress" hyperlink, then follow
"Interview: Jay Giedd" hyperlink). 200. Wallis, supra note 186, at 58.
Neuropsychologist Ruben Gur, of the University of Pennsylvania in
Philadelphia, puts the age of biological maturity at around twenty-one or
twenty-two; Abigail A. Baird, of Dartmouth College, estimates it to be closer
to twenty-five or twenty-six. Bruce Bower, Teen Brains on Trial: The Science of
Neural Development Tangles with the Juvenile Death Penalty, 165 SCI. NEWS
299, 299-300 (2004) (describing use of brain immaturity as evidence to argue
against juvenile death penalty and quoting Baird as saying, "There's no
reason to say adulthood happens at age 18."). 20081 MARQUETTE LAW
REVIEW implications of what they have learned. Some have suggested a link
between the brain's pruning process and the onset of adult schizophrenia and
other disorders at this time of life.'O More generally, the late development of
the frontal lobe, responsible for the "executive functions," may help to
account for teenagers' willingness to indulge in risky behaviors, including
experimentation with alcohol and drugs. Research also indicates that young
people are more willing to take risks in the presence of friends than when
they are alone.0 3 Colleges and universities, where young people in their late
teens and early twenties live close together in a "pressure cooker"
environment, arguably might exacerbate a tendency towards impulsive
behavior that a "sober second thought" would perhaps quell.2 ' Commenting
on the possible link between behavior and brain development, a 1999 article
in Nature Neuroscience stated: The frontal cortex... controls higher cognitive
functions, including emotions, organization of complex tasks and inhibition of
inappropriate behaviors. These abilities develop relatively late and are
generally considered as signs of maturity. It is perhaps no surprise to find that
the brain regions that underlie these functions are among the last to
mature.205 201. Gogtay et al., supra note 187, at 8178 (noting that "adultonset schizophrenia ... is more strongly associated with deficits in latermaturing temporal and frontal regions," and that "alterations either in degree
or timing of basic maturational pattern may at least partially be underlying
these neurodevelopmental disorders"); NIMH, Teenage Brain, supra note 187
("The observed late maturation of the frontal lobe conspicuously coincides
with the typical age-of-onset of schizophrenia . . . which . . . is characterized

by impaired 'executive' functioning."); Wallis, supra note 186, at 65 (Some

experts believe the structural changes seen at adolescence may explain the
timing of such major mental illnesses as schizophrenia and bipolar disorder.
These diseases typically begin in adolescence and contribute to the high rate
of teen suicide.). 202. Wallis, supra note 186, at 61 (citing several
psychological experts' comments to the effect that not only hormones but
also brain development could help to account for the "risky, impulsive
behavior" so often seen in adolescents); Frontline, supra note 187 (follow
"Work in Progress" hyperlink, then follow "Interview: Jay Giedd" hyperlink)
(interview with Dr. Jay Giedd, noting that teens' organizational skills and
decision making should not be held to adult standards because their frontal
lobe has yet to fully develop). 203. Wallis, supra note 186, at 62. 204.
According to Frontline, the late-developing prefrontal cortex has been called
"the area of sober second thought." Frontline, supra note 187 (follow "Work in
Progress" hyperlink, then follow "Adolescent Brains are Works in Progress"
hyperlink). 205. Press Release, Nature Neuroscience, Watching the Brain
Grow up (Oct. 1999), available at
http://www.nature.com/neuro/pressrelease/nn1099.html. [91:625 SUICIDE ON
CAMPUS Indeed, the legal profession itself has taken note of brain
development research: in January 2004, the American Bar Association's
Juvenile Justice Center issued a position paper, Adolescence, Brain
Development and Legal Culpability, opposing the death penalty for juveniles
on the grounds that adolescents are "less morally culpable" than adults by
virtue of their "stark limitations of judgment.,, 2 The statement echoes
arguments put forth in an amicus brief filed on behalf of the American
Medical Association, the American Psychiatric Association, the National
Mental Health Association (home of researchers Dr. Giedd and others heavily
involved in brain development studies), and other similar organizations2 on
behalf of the sixteen- and seventeen-year-old juveniles in Roper v. Simmons,
where the Supreme Court invalidated the death penalty for young people of
those ages in 2005.208 Speaking of adolescents as a whole (and, specifically,
of those aged sixteen and seventeen) the medical groups' brief noted that
they "are more impulsive than adults" and "more susceptible to stress, more
emotionally volatile, and less capable of controlling their emotions than
adults."2 Therefore, "the average adolescent cannot be expected to act with
the same control or foresight as a mature adult."21 The brief goes on to link
adolescent behavior to brain development, specifically observing that the
maturation process continues beyond the age of eighteen: Behavioral
scientists have observed these differences for some time. Only recently,
however, have studies yielded evidence of concrete differences that are
anatomically based. Cutting-edge brain imaging technology reveals that
regions of the adolescent brain do not reach a fully mature state until after
the age of 18. These regions are precisely those associated with impulse
control, 206. ADAM ORTIz, A.B.A. JUV. JUSTICE CTR., ADOLESCENCE, BRAIN
DEVELOPMENT AND LEGAL CULPABILITY 3 (2004), available at
http://www.abanet.org/ crimjust/juvj us/Adolescence.pdf. 207. Brief of the Am.
Med. Ass'n et al. as Amici Curiae in Support of Respondent, Roper v.
Simmons, 543 U.S. 551 (2005) (No. 03-633). Also joined in the brief were the
American Psychiatric Association, American Society for Adolescent Psychiatry,
American Academy of Child & Adolescent Psychiatry, American Academy of
Psychiatry and the Law, National Association of Social Workers, the Missouri
Chapter of the National Association of Social Workers, and the National
Mental Health Association. 208. Roper v. Simmons, 543 U.S. 551 (2005). 209.

Brief as Amici Curiae in Support of the Respondent, supra note 207, at 2. 210.
Id. 2008] MARQUETTE LAW REVIEW regulation of emotions, risk assessment,
and moral reasoning. Critical developmental changes in these regions occur
only after late adolescence. While he did not rely specifically on data from
brain development technology to decide that the Eighth Amendment
prohibits the death penalty for persons below the age of eighteen, Justice
Kennedy's majority opinion did cite "scientific and sociological studies" in
amicus briefs confirming a "'lack of maturity and an underdeveloped sense of
responsibility"' more prevalent in young people than adults that "'often result
in impetuous and ill-considered actions and decisions.' 212 Despite the
medical groups' partial reliance on brain studies in their Roper v. Simmons
brief, the researchers conducting those studies are very cautious in their
statements about the implications of their discoveries; it is simply too early,
they say, to base social policy on what they have learned. Put another way,
the leap from structure to function is much more complicated than simple
age-related correlations between the brain's development and the behavior
of young people in their late teens and early twenties.214 Yet no one doubts
that there is a link, even though we are far from understanding just how that
link works.215 Certainly, while both cognitive behaviorists and brain
development researchers can tell us about maturational changes extending
at least into the early twenties, no one has proposed that we change the legal
ages for behaviors such as driving (generally, sixteen), voting and contractmaking (eighteen), or drinking (twenty-one). 6 211. Id. at 2-3. 212. Roper,
543 U.S. at 569 (quoting Johnson v. Texas, 509 U.S. 350, 367 (1993)). 213.
See, e.g., Wallis, supra note 186, at 65 (noting that "[b]rain scientists tend to
be reluctant to make the leap from laboratory to real-life, hard-core
teenagers."). 214. See, e.g., Frontline, supra note 187 (follow "Work in
Progress" hyperlink, then follow "Adolescent Brains are Works in Progress"
hyperlink) (report of Sarah Spinks). 215. See, e.g., Wallis, supra note 186, at
65 (noting that despite the reluctance of scientists to leap from the laboratory
to real life, "It is clear.., that there are implications in the new research for
parents, educators and lawmakers"); Frontline, supra note 187 (follow "Work
in Progress" hyperlink, then follow "Interview: Jay Giedd" hyperlink) (similarly
noting such reluctance but stating, "It is a good hypothesis that if a particular
structure is still immature, the functions it governs will show immaturity").
216. Writing in Roper v. Simmons, Justice Kennedy observed, "Drawing the
line at 18 years of age is subject, of course, to the objections always raised
against categorical rules. The qualities that distinguish juveniles from adults
do not disappear when an individual turns 18[,] ... [but] [t]he age of 18 is the
point where society draws the line for many purposes between childhood and
adulthood. It is, we conclude, the age at which the line for death eligibility
ought to rest." Roper, 543 U.S. at 574. Appendices to the Court's opinion list
individual state [91:625 SUICIDE ON CAMPUS This Article offers a much more
modest proposition: Given the current state of our knowledge about normal
maturation, we can expect young people of the ages of most undergraduates,
at least, to be more inclined than older adults toward reckless or impulsive
behavior, and to act, at times, without full appreciation for the consequences
of what they are doing. These tendencies are exacerbated by living situations
where almost everyone is at the same age and stage of life. The result is an
atmosphere where the stresses of academic life can readily be experienced
as overwhelming. All of these factors add up to a recipe for a psychologically
vulnerable student to fall prey to suicidal ideation and perhaps even to carry
out the idea. While schools cannot possibly be "babysitters" (as one court put

it) 217 for their students, we know there are situations in which college
administrators or other university personnel are in fact aware that a
particular individual student is seriously suicidal. In that situation, an
appreciation for the general nature of student immaturity makes it
appropriate to require, as a matter of law, that the university employee take
reasonable steps to prevent the potential infliction of self-harm. V. THE
ARGUMENT FROM MORALITY In his 1992 article in the Chronicle of Higher
Education, Today's College Students Need Both Freedom and Structure,"8
Professor Gary Pavela maintains that, despite the demise of the rigid control
that marked in loco parentis, "colleges still retain a 'special relationship' with
statutes establishing, inter alia, the minimum age to vote (18 in all cases), id.
at 581-83; to serve on a jury (generally 18, but 19 in Alabama and Nebraska,
and 21 in Mississippi and Missouri), id. at 583-85; and to marry without
parental or judicial consent (generally 18, but 16 in Georgia and Maryland, 19
in Nebraska, and in Mississippi, 15 for females and 17 for males), id. at 58587; see also Wallis, supra note 186, at 65 ("In light of what has been learned,
it seems almost arbitrary that our society has decided that a young American
is ready to drive a car at 16, to vote and serve in the Army at 18 and to drink
alcohol at 21. Giedd says the best estimate for when the brain is truly mature
is 25, the age at which you can rent a car. 'Avis must have some pretty
sophisticated neuroscientists,' he jokes."). 217. Beach v. Univ. of Utah, 726
P.2d 413, 419 (Utah 1986) Fulfilling [the role of custodian] would require the
institution to babysit each student, a task beyond the resources of any
school. But more importantly, such measures would be inconsistent with the
nature of the relationship between the student and the institution, for it
would produce a repressive and inhospitable environment, largely
inconsistent with the objectives of a modern college education. 218. Pavela,
supra note 175. See generally supra notes 175-78 and accompanying text
(discussing Professor Pavela's ideas in this article). 2008] MARQUETTE LAW
REVIEW [91:625 students that requires them to exercise some responsibility
for students' safety and behavior." In his view, this responsibility amounts to
a "moral obligation[]," which he predicts "courts and legislatures will sooner
or later transform into a legal duty., 219 Pavela is actually discussing
disciplinary obligations on the part of institutions of higher learning that he
thinks appropriately extend to situations of hazing, substance abuse, sexual
assault, and the like. 220 As previously mentioned, some courts have already
found a duty in instances involving residential security221 and hazing in an
on-campus fraternity.222 The "moral obligation" to protect student safety
must surely have been in the minds of the drafters of the American Law
Institute's Restatement (Third) of Torts section 40, which added "a school with
its students" to the "special relationships" previously identified as grounds for
creating a duty of care.223 This duty includes, according to the reporter's
notes, at least some situations involving institutions of higher learning. 4 Of
course, the new draft does retain the general "no-duty-to-rescue" rule.225
This rule itself is generally defended as consistent with the liberty properly
pertaining to the individual in a free society.226 It has, however, from time to
time been vehemently attacked for the inherent immorality of its position. 7
Dean Prosser famously found decisions 219. Pavela, supra note 175. Pavela is
in part expressing his agreement with remarks to a similar effect given by
Robert Bickel, professor of law at Stetson University, at the 1992 National
Conference on Law and Higher Education. Id. 220. Id. The "moral obligation"
Pavela describes is more amorphous than that advocated here. He refers to
"the moral obligations inherent in the student-teacher relationship, including

the obligation to enforce a standard of civility on campus." Id. 221. Mullins v.

Pine Manor Coll., 449 N.E.2d 331, 337 (Mass. 1983). 222. Furek v. Univ. of
Del., 594 A.2d 506, 522-23 (Del. 1991). 223. RESTATEMENT (THIRD) OF
TORTS 40(a), (b)(5) (Proposed Final Draft No. 1, 2005); see supra notes 6770 and accompanying text (discussing that section). 224. RESTATEMENT
(THIRD) OF TORTS: LIABILITY FOR PHYSICAL HARM 40 (Proposed Final Draft
No. 1, 2005). 225. Id. 37. Section 37 provides: "An actor whose conduct has
not created a risk of physical harm to another has no duty of care to the other
unless a court determines that one of the affirmative duties provided in 3844 is applicable." Id. 226. See, e.g., Francis H. Bohlen, The Moral Duty to Aid
Others as a Basis of Tort Liability, 56 U. PA. L. REV. 217 (1908) (noting the
distinction between misfeasance and nonfeasance as "deeply rooted in the
common law," id. at 219, and concluding that "duties to take positive action
for the benefit and protection of others attach only to certain relations," and
then extend only so far as "absolutely necessary" for their protection, id. at
243); Richard A. Epstein, A Theory of Strict Liability, 2 J. LEGAL STUD. 151,
189-203 (1973) (arguing against Ames, infra note 229, on grounds of the
importance of individual liberty and the problem of drawing lines). Epstein is
particularly concerned with the necessity for a causal connection between
defendant's act and plaintiff's injury. 227. See, e.g., Ernest J. Weinrib, The
Case for a Duty to Rescue, 90 YALE L.J. 247, 293 SUICIDE ON CAMPUS
upholding the no-duty-to-rescue rule "revolting to any moral sense. 22 8
Although he failed to carry the day with this contention, other writers have
from time to time espoused the notion that our common sense of the moral
duty to help someone in peril, especially when that can be accomplished
without danger or even great inconvenience to oneself, should, in fact, be a
legal requirement. The famous essay by James Barr Ames, Law and Morals,
which appeared in the Harvard Law Review of 1908,229 began by tracing the
historical evolution in the common law between liability in tort and a finding
of blameworthiness, and concluded with the observation, "We should all be
better satisfied if the man who refuses to throw a rope to a drowning man or
to save a helpless child on the railroad track could be punished and be made
to compensate the widow of the man drowned and the wounded child."230
Ames noted the practical line-drawing difficulties inherent in the imposition of
a positive duty but observed, "that difficulty has continually to be faced in the
law., 231' He therefore proposed a "possible working rule": One who fails to
interfere to save another from impending death or great bodily harm, when
he might do so with little or no inconvenience to himself, and the death or
great bodily harm follows as a consequence of his inaction, shall be punished
criminally and shall make compensation to the party injured or to his widow
and children in case of death. Writing along similar lines almost seventy years
later, Marshall Shapo singled out universities for special attention, along the
lines of the Restatement's "special relation": "modern educational institutions
represent great clusters of power, and, even given a laissez faire (1980)
(noting that "the common law is already instinct with the attitude of
benevolence on which a duty to rescue is grounded" and that a duty of easy
rescue of another in an emergency would satisfy "those who believe that law
should attempt to render concrete the notion of ethical dealing between
persons"). Weinrib argues that the duty he proposes satisfies the
requirements not just of deontological concerns, but of utilitarianism as well.
Id.; see also MARSHALL S. SHAPO, THE DUTY TO ACT: TORT LAW, POWER, &
PUBLIC POLICY (1977). 228. WILLIAM L. PROSSER, HANDBOOK OF THE LAW
OF TORTS 54, at 336 (3d ed. 1964). 229. James Barr Ames, Law and Morals,

22 HARV. L. REV. 97 (1908). 230. Id. at 112-13. 231. Id. at 112. 232. Id. at
113. 20081 MARQUETTE LAW REVIEW approach to student life, perhaps the
law should recognize a new relation of dependence fostered in students by
that power, a relation quite akin to that of industrial workers with their
employers." 3 While the common law has not responded to suggestions of a
positive duty to rescue, both judicial and legislative policies have developed
that help to encourage the moral impetus to help one in imminent peril.
Ernest Weinrib notes both courts' increasingly favorable treatment of rescuers
and their expansion upon the "special relationship" doctrine.- 4 "Good
Samaritan" statutes, in force in fortynine states and the District of Columbia,
immunize physicians and other healthcare providers from negligence actions
when they attempt to provide care in emergency situations.23 ' And three
states have, in fact, passed laws requiring a person at the scene of an
emergency to provide reasonable assistance, potentially including a duty to
contact appropriate authorities. 36 This Article does not propose anything so
grandiose as a general abolition of the "no-duty-to-rescue" rule. The point
here rests upon the thought expressed by Ernest Weinrib that "the role of the
common-law judge centrally involves making moral duties into legal ones,,
237 and the contention that in some situations, where college personnel are
aware of the serious and imminent threat of suicide on the part of a student,
it is incumbent upon them to take reasonable steps to prevent the death. VI.
OBJECTIONS TO A RULE OF POTENTIAL NON-CLINICIAN LIABILITY There are
important substantive objections and counter-arguments to any rule of law
imposing a duty upon non-clinician college and university personnel to take
reasonable steps to protect a seriously suicidal student against self-harm,
notably indicated by the finding (so surprising to psychologists) of "reluctance
on the part of many university officials to know the actual identity of suicidal
students, believing that not knowing will protect the institution from liability
in the event of a student's suicide." 8 These objections are well articulated
233. SHAPO, supra note 227, at 41. 234. Weinrib, supra note 227, at 248.
235. BARRY R. FURROW ET AL., HEALTH LAW 6-5(c) (2d ed. 2000). 236.
MINN. STAT. 604A.01 (2000 & Supp. 2008); R.I. GEN. LAWS 11-56-1 (2002);
VT. STAT. ANN. tit. 12, 519 (2002). 237. Weinrib, supra note 227, at 263.
238. Haas et al., supra note 31, at 1234; see supra text accompanying notes
58 and 102. [91:625 SUICIDE ON CAMPUS in MIT v. Shin, in briefs filed with
the Massachusetts Appeals Court by MIT administrators Arnold Henderson
and Nina Davis-Millis, appealing Judge McEvoy's denial of summary judgment
as to them,23 and by three amicus curiae briefs filed the same day by groups
representing almost all institutions of higher education in the country.24
They deserve serious examination prior to any specific proposal to address
the salient legal issue. A. Legal Arguments 1. "Special Relationship" Criteria
Are Lacking Restatement (Second) of Torts section 314 states the "no-dutytorescue
ule: "The fact that the actor realizes or should realize that action on his part is
necessary for another's aid or protection does not of itself impose upon him a
duty to take such action., 241 The Comments make clear that absent a
special relationship, foreseeability alone does not trigger a duty to act on
behalf of another; furthermore, any such duty is likely to arise only when the
actor has created the situation that endangers the other or has actual control
over a third person, or over land or chattels, that themselves create the
dangerous conditions.242 Section 314A, the "special relationship" section,
includes custodial situations among those giving rise to its exception to the

no-duty rule.243 Colleges and universities clearly do not have either custody
or control of their students, even those who live on campus. Furthermore,
there is no known case where an institution of higher learning actually caused
a student's suicidal impulse. Under these circumstances, argued the MIT
administrators, a "special relationship" is necessarily lacking, for the special
relationship must be a pre-existing one; it cannot be triggered by
foreseeability 239. See Memorandum in Support of Petition for Relief Under
G.L. ch. 231, 118 (First Paragraph) by MIT Administrators Arnold Henderson
and Nina Davis-Millis, Shin v. MIT, No. 2006-J-0099 (Mass. Super. Feb. 24,
2006) [hereinafter MIT Brief]. 240. See Ass'n Motion, supra note 13, at 1
(claiming to represent "most higher education institutions in the United
States"); Brief of Amici Curiae American Council on Education et al. in Support
of Petition for Relief under G.L. ch. 231, 118 (First Paragraph) by MIT
Administrators Arnold Henderson and Nina Davis-Millis, Shin v. MIT, No. 2006J-0099 (Mass. Super. Feb. 24, 2006) [hereinafter Ass'n Brief]; Nat'l Colleges
Brief, supra note 13; Mass. Colleges Brief, supra note 13. 241. RESTATEMENT
(SECOND) OF TORTS 314 (1965). 242. Id. cmts. a-d (especially cmt. a). 243.
Id. 314A(4). 2008] MARQUETTE LAW REVIEW alone.2" Yet that is the only
factor that could conceivably be deemed to create a legal duty here. Judge
Kiser was wrong in his Schieszler v. Ferrum245 decision, the argument goes,
for he relied upon the sole factor of foreseeability in ruling that Ferrum
College and its dean of student affairs, David Newcombe, had a duty to
protect Michael Frentzel from his threatened suicide. The contention of this
Article is simply the point that, for all the reasons cited above, the law in this
area is changing, and that change is one that reflects a better appreciation
for the realities of the circumstances of a seriously suicidal student attending
a college or university-particularly, a student who is in residence there. The
American Law Institute, in its draft of the Restatement (Third) of Torts, has
taken account of this fact and lent its considerable weight to the notion that
there may be situations in which it is appropriate for courts to find a special
relationship between an institution of higher learning and a given enrolled
student. 2 ' This is not an argument that the "noduty-to-rescue" rule should
be overturned or that colleges and universities have a "special relationship"
with all of their students, which would be a totally unworkable rule. It is both
the actual knowledge on the part of the non-clinician college administrator,
together with the imminence of the threat, that can create the duty to take
reasonable steps to prevent the self-harm. Foreseeability is thus the most
important factor in triggering the duty, but not the only one. Context is
everything in this kind of question; it will necessarily require a case-by-case
assessment to determine whether the facts can appropriately be
characterized as creating the duty inherent in a special relationship. In this
respect, protests in the briefs supporting MIT in Shin that Judge McEvoy's
opinion was too open-ended and pointed the way to a standardless and
indeterminate duty247 are well taken; those objections should be taken into
account in framing an operative rule. 2. The Double-Bind: Liable Whatever
the Institution Does? Schools also feel caught in a bind with respect to
countervailing 244. See MIT Brief, supra note 239, at 5-13. 245. Schieszler v.
Ferrum Coll., 236 F. Supp. 2d 602 (W.D. Va. 2002); see supra notes 21- 24 and
accompanying text; see also MIT Brief, supra note 239, at 12-13. 246.
RESTATEMENT (THIRD) OF TORTS 40 (Proposed Final Draft No. 1, 2005). 247.
See MIT Brief, supra note 239, at 13-14; Ass'n Brief, supra note 240, at 8-11;
Nat'l Colleges Brief, supra note 13, at 6-7; Mass. Colleges Brief, supra note
13, at 25-30. 248. See infra notes 297-98 and accompanying text. [91:625

SUICIDE ON CAMPUS federal policy. 4 9 The privacy concerns of FERPA (with

its emergency exception) have already been mentioned.2 0 More
problematic, possibly, is the difficulty some schools are encountering by
demanding withdrawal when a student appears to be suicidal or to be
suffering from severe mental problems. Most notorious in recent months is
the case of Jordan Nott, who sued George Washington University for
dismissing him from campus via letter for "endangering behavior," thereby
violating the code of student conduct, two days after he had checked himself
into the University Hospital on grounds of depression, sleeplessness, and
suicidal ideation."' The suit eventually settled.252 Other students have also
complained of suspensions or forced withdrawals, and last year, the U.S.
Department of Education's Office of Civil Rights warned several schools that
students with mental health problems are protected by federal law.253
Specifically, section 504 of the Federal Rehabilitation Act of 1973 prohibits
recipients of federal funds from discriminating on the grounds of
disability,254 while the Americans with Disabilities Act prohibits such
discrimination on the part of any entity that serves the public. 255 Between
these statutes and the Schieszler 249. See Mass. Colleges Brief, supra note
13, at 24-25. 250. See supra notes 117-23 and accompanying text. 251.
Susan Kinzie, GWU Suit Prompts Questions of Liability, WASH. POST, Mar. 10,
2006, at Al; see also Editorial, Depressed? Get Out!, WASH. POST., March 13,
2006, at A14 (describing GW's actions as "an excellent lesson in how not to
respond to serious depression"); Rob Capriccioso, Counseling Crisis, INSIDE
HIGHER ED, Mar. 13, 2006,
http://www.insidehighered.com/news/2006/03/13/counseling (discussing the
Nott case in some detail, with comments from a spokeswoman for GW). 252.
Trachtenberg, supra note 2. Stephen Joel Trachtenberg is the president of
George Washington University. Id. In his essay (commenting on the Virginia
Tech killings) he notes the Nott situation and states that "we stand by the
result that a life may have been saved." Id. 253. See Julie Rawe & Kathleen
Kingsbury, When Colleges Go on Suicide Watch, TIME, May 22, 2006, at 62,
62-63 (reporting the experience of Anne Giedinghagen at Cornell, as well as
the case of Jordan Nott, and noting that several students complained to the
Department of Education's office about being "summarily booted"); see also
Capriccioso, supra note 251, at 4 (reporting, in addition to the Nott case, the
story of Sue Schaller, forced to take "mandated leave" from New York
University, and also detailing actions of the U.S. Department of Education's
Office of Civil Rights ("OCR"). The latter included a finding of violation on the
part of Bluffton University in Ohio, which removed a student following a
suicide attempt without any due process; said the OCR, the university "did
not consult with medical personnel, examine objective evidence, ascertain
the nature, duration and severity of the risk to the student or other students,
or consider mitigating the risk of injury to the student or other students.").
254. 29 U.S.C. 794 (2000 & Supp. V 2005). 255. 42 U.S.C. 12101-12213
(2000 & Supp. V 2005). The specific provision is 12182(a), providing for
application to any party that "operates a place of public accommodation." Id.
2008] MARQUETTE LAW REVIEW and Shin opinions, notes Time magazine,
"schools are left 'with the quandary of being sued no matter what they
do.',,256 Finding the fine line between "damned if you do, damned if you
don't" can concededly feel like a frustrating task. Jordan Nott has vented his
own exasperation over George Washington's apparent greater concern with
its own potential liability than with his mental health: "'When you are looking
out for your own liability, you're not really looking out for the interests of the

student, you're looking out for yourself.... I suppose every person has to look
out for themselves, but this goes way beyond a certain line.' 257 In the wake
of several incidents similar to his, the Department of Education's Office of
Civil Rights has notified schools that such extreme actions are justifiable
"only when there is 'a high probability of substantial harm and not just a
slightly increased, speculative or remote risk. ' ''8 Partly as a result of the
Jordan Nott incident,259 the Virginia legislature has unanimously taken the
extreme step of passing a law banning public universities from expelling or
punishing students simply because of their suicidal ideation or behavior."
Persons associated with institutions of higher learning in the state were
generally dismayed by an action they deemed to undercut their flexibility in
dealing with troubled students.26 ' Interestingly, the legislation begins with a
positive requirement that has been virtually overlooked in the news media
and public pronouncements. The legislation reads as follows: 256. Rawe &
Kingsbury, supra note 253, at 62-63 (quoting United Educators, which insures
more than 1,100 colleges and secondary schools nationwide). 257.
Capriccioso, supra note 251. It is significant that in Nott's case, the
healthcare provider shared patient information with the school
administration-a context not contemplated here. However, his observation
makes a relevant point, whatever the means of the administration's
knowledge and involvement. 258. Rawe & Kingsbury, supra note 253, at 63.
259. Josh Keller, Virginia Legislature Votes to Bar Colleges from Dismissing
Suicidal Students, CHRON. HIGHER EDUC. (Wash., D.C.), Mar. 9, 2007, at A41
(noting that the bill's sponsor cited the case of Jordan Nott, as well as a
similar situation at Hunter College of the City University of New York that
settled for $65,000). 260. VA. CODE ANN. 23-9.2:8 (Supp. 2007). 261. See,
e.g., Keller, supra note 259 (quoting the dean of student affairs and the
director of student health at Washington and Lee University (a private school)
about their opposition to the bill and the need for any school to have all
options open in such situations); see also Greg Esposito, Kaine Likely to Sign
Suicide Bill, ROANOKE TIMES (Roanoke, Va.), Mar. 17, 2007, at B1 (noting
letters to Governor Tim Kaine from the presidents of the Virginia Association
of Student Personnel Administrators and the Virginia Association of College
and University Housing Officers calling the bill "'a dramatic and intrusive
effort' that 'will systematically impair our ability to assist potentially suicidal
students."'). [91:625 SUICIDE ON CAMPUS The governing boards of each
public institution of higher education shall develop and implement policies
that advise students, faculty, and staff including residence hall staff, of the
proper procedures for identifying and addressing the needs of students
exhibiting suicidal tendencies or behavior. The policies shall ensure that no
student is penalized or expelled solely for attempting to commit suicide, or
seeking mental health treatment for suicidal thoughts or behaviors. Nothing
in this section shall preclude any public institution of higher education from
establishing policies and procedures for appropriately dealing with students
who are a danger to themselves, or to others, and whose behavior is
disruptive to the academic community. 262 Though the circumstances
surrounding the death of Michael Frentzel were not mentioned in connection
with the passage of this law, the wording suggests that the legislature wished
both to respect the "special relationship" cited by Judge Kiser in Schieszler v.
Ferrum College263 and to avoid the pitfalls posed by the Americans with
Disabilities Act that formed the basis for Jordan Nott's lawsuit. The proposal of
this Article is neither that students should be forced to withdraw (except,
perhaps, in the most extreme cases, where continuation in school appears

not to be a practical possibility for the student), nor that schools should be
precluded from requiring a student to take a leave of absence for a time. On
the one hand, students may well not have access at home to the resources
available at the college or university. On the other, they may be too troubled
to deal well with the rigors of academic life, or their behavior may be
disruptive to the academic environment. This Article does not seek to address
those issues, which seem better left to psychological experts than to lawyers;
rather, the proposal here is that school administrators who become aware
that a student is seriously suicidal should take reasonable steps to protect the
student's safety-a duty that ordinarily could be fulfilled simply by contacting
the student's parents or other responsible party. Bringing them into the
process of deciding what course of action is in the student's best interest
should help to preclude-not to foster- 262. 23-9.2:8 (emphasis added). 263.
236 F. Supp. 2d 602 (W.D. Va. 2002); see supra notes 21-24 and
accompanying text. Note, however, that as a private institution, Ferrum
College would not be bound by the legislation. 2008] MARQUETTE LAW
REVIEW potential liability on the institution's part. B. Policy Arguments 1. The
Danger of "Perverse Incentives" on Both Sides From a policy standpoint,
opponents argue that the imposition of a duty of care on non-clinician
administrators would create "perverse incentives ' '26 4 for two groups.
Administrators (teachers, coaches, residence personnel, and others) would
disengage from their traditional nurturing and general counseling roles, in an
effort to avoid becoming "aware" of students' severe mental health problems,
and thereby avoid any potential for liability."' Students would become wary of
approaching those same administrators in order to preserve their own privacy
and avoid possible disclosure of confidential information (let alone the actions
that might follow, such as suspension or forced withdrawal) .266 Cases in the
public eye provide fodder for this argument. Jordan Nott has stated that he
"would never seek help at a campus counseling center again., 267 As
reported by Time magazine, Anne Giedinghagen attempted (unsuccessfully)
to "hide" her mental state from Cornell University personnel in order to stay
on campus." Sue Schaller was forced to take "mandated leave" by NYU
administrators, even though a doctor who treated her in the university's
hospital recommended that 264. Ass'n Motion, supra note 13, at 3 (arguing
that Judge McEvoy's holding "has engendered the opposite of its intended
effect"). 265. See MIT Brief, supra note 239, at 13 (noting that Judge
McEvoy's ruling "already is causing severely harmful consequences for the
large number of college students with significant mental health problems");
see also Ass'n Brief, supra note 240, at 6-7 (attributing the lower suicide rate
among college students than among similar-aged peers to the "'more
supportive peer and mentor environment' found on university campuses,"
and predicting a lessening of that support if the ruling is followed); Nat'l
Colleges Brief, supra note 13, at 3 (positing "detrimental effects" that the
ruling might have on "extensive student support systems" in place at most
colleges and universities "which are important and beneficial both for those
students who need mental healthcare and those who do not"). 266. See MIT
Brief, supra note 239, at 14 n.10 (predicting that students with suicidal
ideation might "suffer alone and in silence," rather than seek help from
school personnel who, they fear, might force them to leave the campus); see
also Nat'l Colleges Brief, supra note 13, at 10-11 (predicting that if students
anticipate parental notification or hospitalization, they might decide not to
disclose information about their mental health history or their current
problems). 267. Capriccioso, supra note 251. 268. Rawe & Kingsbury, supra

note 253, at 62. [91:625 SUICIDE ON CAMPUS she be allowed to return to

campus. 69 Complaints to the U.S. Department of Education's Office of Civil
Rights are additional evidence of perceived discrimination against students
with mental health problems, often allegedly engaged in for purposes of
avoiding liability.27 Yet with each of the three above-named students, the
university's action was taken after receiving reports from medical
professionals involved in the respective student's case. Those actions may
have been clumsy (as in the case of Jordan Nott, particularly) or ill-advised
(as in NYU's apparent decision to act contrary to Sue Schaller's doctor's
advice).27 1 Yet an appropriate rule of liability for ignoring seriously suicidal
behavior of which university administrators are aware need not result in such
knee-jerk reactions grounded in fear of liability, rather than in considered
judgments of what is best for the student. Furthermore, if the duty may be
discharged in almost every instance by parental notification, the result is
more likely to be the best possible care for the student, which might well be
on campus, not at home. 2. Non-Clinician Administrators Lack the Expertise
to Make These Judgment Calls Opponents of placing any duty on
administrators point out that, as non-clinicians, they are not equipped to
make the sensitive medical judgments that necessarily go into any
determination that a student presents a serious suicide risk. Where students
are already in counseling, if non-clinician administrators act on their own
hunches or fears, they may well do something-such as notifying parents or
suspending students from school-that is quite contrary to the considered
course of therapy specifically recommended by the student's counselors.272
The implicit assumption is that administrators' roles 269. Capriccioso, supra
note 251. 270. See supra notes 251-58 and accompanying text; see also
Rawe and Kingsbury, supra note 253, at 62 (noting that many universities
have adopted policies of mandatory leave in order to avoid student suicides).
"But a tragic result, say psychiatrists and student advocates, is that
emotionally distressed students may be less willing to come forward and get
the professional help they need." Id. 271. After her condition worsened, and
following talks with her therapists, Anne Giedinghagen went home for
treatment in a psychiatric hospital. Rawe & Kingsbury, supra note 253, at 63.
272. See MIT Brief, supra note 239, at 13-14; see also Ass'n Brief, supra note
240, at 13- 14 (pointing out that in addition to lacking diagnostic expertise,
non-clinicians have no power to commit students to medical care
involuntarily); Mass. Colleges Brief, supra note 13, at 31- 33 (imposition of a
duty may create conflicts between clinicians and administrators); Nat'l
Colleges Brief, supra note 13, at 8-10 (non-clinicians may be more inclined
either to contact parents or to seek separation from the university, contrary
to therapists' recommendations). 2008] MARQUETTE LAW REVIEW should be
limited to suggesting to students that they seek help from clinical counselors,
perhaps following up to ask whether the students have done so. No one
doubts the inability of non-clinicians to make medical judgments or to
recommend the best possible course of therapeutic action. No reasonable
rule of law should require that they do so. Consider, however, the cases
under consideration here. Elizabeth Shin's housemaster, Nina Davis-Millis,
knew that Elizabeth had held a knife to her chest the night before her
parents' visit and had ingested a non-lethal mixture of alcohol and Tylenol
later the same night of their surprise birthday party. The next day-the actual
day of her death-two of Elizabeth's friends had told the administrator that she
intended to commit suicide that day. In fact, Ms. Davis-Millis herself had an
upsetting telephone call with Elizabeth that same morning.2 3 According to

her deposition, Ms. Davis-Millis reported this information to Dean Arnold

Henderson twice on the morning of the day in question.274 Dean Henderson
later claimed that he did not recall the substance of the conversation, and it
appears that at the meeting of the "deans and psychs" that morning, no such
information was conveyed to the clinicians caring for Elizabeth.275 The
suggestion here is that the administrators had a duty at least to see that
Elizabeth's counselors had this seemingly highly relevant information. In fact,
their admitted lack of medical expertise would only enhance such an
argument. Again, in Schieszler,76 campus personnel at Ferrum College were
aware that Michael Frentzel, a freshman living in an on-campus dormitory,
had a history of emotional difficulties.277 They had required him to attend
anger management sessions before returning for a second semester of
school.278 Even so, an argument between Michael and his girlfriend, Crystal,
attracted intervention by the resident assistant and 273. See Shin Brief, supra
note 15, at 5. The Brief states that according to Davis-Millis's testimony, the
call occurred about 9:45 A.M. Id. Elizabeth had accused her of wanting to
send her home and had said angrily, "you won't have me to worry about any
more." Id. (citing Deposition of Nina Davis-Millis Oct. 16, 2003). 274. Id. at 5-7
(quoting Deposition of Nina Davis-Millis Oct. 16, 2003). 275. Id. at 6-7
(quoting Deposition of Arnold Henderson Nov. 18, 2003). The "deans and
psychs" meeting is a weekly meeting of MIT administrators and clinical
psychologists to discuss students whose mental health is deemed to be at
risk. Shin v. MIT, No. 02-0403, 2005 WL 1869101, at *5, *13 (Mass. Dist. Ct.
June 27, 2005). 276. See Schieszler v. Ferrum Coll., 236 F. Supp. 2d 602 (W.D.
Va. 2002); see supra notes 21-24 and accompanying text (discussing the case
generally). 277. Schieszler, 236 F. Supp. 2d at 605. 278. Id. [91:625 SUICIDE
ON CAMPUS campus police.279 Shortly after that incident, Crystal received a
message from Michael of his suicidal intentions. 0 When she showed it to
campus police, they found him locked in his room, with bruises on his head
that he acknowledged to be self-inflicted. 28 ' David Newcombe, dean of
student affairs, then required Michael to sign a statement that he would not
hurt himself. 82 Further suicide threats within the next few days, which
Crystal reported to campus authorities, resulted in no action other than a
prohibition that she not visit his room.283 When Crystal finally pressed a note
upon campus police in which Michael had said, "only God can help me now,"
they went to his room and found that he had hanged himself with his belt.
While the non-clinician administrators at Ferrum College (notably, the dean of
student affairs) could not reasonably be held to a standard of medical
expertise, these facts, if borne out by the evidence, surely paint a situation in
which a reasonable person would consider Michael Frentzel to pose a serious
threat of imminent suicide. Asking the student to sign an agreement not to
harm himself obviously fails to address his emotional disturbance, and no
reasonable person (especially one experienced at dealing with students)
should think it trustworthy. As in the case of Elizabeth Shin, the dean's very
lack of medical ability only enhances an argument that he had a duty to take
steps to look out for Michael's safety-by calling in campus counselors,
contacting his aunt and guardian, LaVerne Schieszler, or both. Given the very
direct involvement of campus personnel in Michael's life and problems up to
that point, it is neither unjust nor inaccurate to say that the course of events
created a "special relationship" between them, as envisioned by both the
Second and Third Restatements. 5 Sanjay Jain's situation might present a less
strong case; yet arguably, someone from the University of Iowa should have
contacted the family about their eighteen-year-old freshman son. In his first

semester, he became moody, skipped a number of classes, experimented

with drugs and alcohol, and was involved in an egg-throwing incident.2 6
Beth Merritt, the hall coordinator for Sanjay's dormitory, disciplined him for
279. Id. 280. Id. 281. Id. 282. Id. 283. Id. 284. Id. 285. See supra notes 60-70
and accompanying text. 286. Jain v. State, 617 N.W.2d 293,295 (Iowa 2000).
2008] MARQUETTE LAW REVIEW these activities by imposing community
service, requirements to attend alcohol and drug education classes, and one
year of disciplinary probation for smoking marijuana in his room.' With this
series of events as the operative context, Ms. Merritt was contacted after
resident assistants found Sanjay arguing with his girlfriend over the fact that
he was keeping his moped in his room with the intention of killing himself
with the exhaust fumes." When she met with him, he was evasive about the
incident and his alleged suicidal intentions.28 9 She told him to move the
moped (which he failed to do), encouraged him to consult university
counselors, gave him her home telephone number, asking that he call if he
thought he was going to hurt himself, and received assurances from him that
he would discuss his problems with his parents during the upcoming
Thanksgiving holiday.2 Ms. Merritt also consulted with the assistant director
for residence life, David Coleman. 291 Her assessment at that point was that
"Sanjay revealed more tiredness . . . than hopelessness or despair. '' 292
When Sanjay returned after the holiday (not having discussed any problems
with his parents), Merritt, seeing him briefly, asked how things were going;
his response was "good."2' 93 The moped was still in his room, however, and
he told his roommate, Scott, that he planned to kill himself with its exhaust
fumes one night when Scott was not there. Scott took this lightly, but a few
days later, Sanjay followed through on his threat.29 In this case, Iowa had an
unwritten policy of contacting a student's parents after a suicide attempt; the
decision whether to do so lay with the dean of students. Neither Beth Merritt
nor her supervisor, David Coleman, had contacted him with information,
which might have prompted action on his part. Here again, two university
administrators, lacking medical expertise themselves, were concerned about
the student's situation but concluded they had done all that was necessary
under the circumstances. This case was not argued on the grounds of "special
relationship,"2' 95 and there is no way to tell how a jury might have reacted
to the relevant facts. Ms. Merritt was not equipped to 287. Id.; see supra
notes 87-94 and accompanying text (discussing the case generally). 288.
Jain, 617 N.W.2d at 295. 289. Id. 290. Id. 291. Id. 292. Id. at 296. 293. Id. 294.
Id. 295. See supra notes 60-70 and accompanying text. [91:625 SUICIDE ON
CAMPUS diagnose the seriousness of Sanjay's condition, but their interactions
did take place in the context of a pattern of problematic student behavior.
The Jain family grounded their suit in the university's failure to notify them of
his suicide attempt.2 " The validity of their claim may be questionable, even
under the rule proposed here, but what does seem clear is that if the family
had been notified, they would have had no basis for a suit at all. VII. THE
PROPOSED RULE OF LAW In light of all the foregoing considerations, and for
the protection of both campus administrators and students, I propose the
following rule, applicable under Restatement of Torts (Second) section 314A,
or Restatement of Torts (Third) section 40, concerning a "special relationship"
between campus personnel and a given student: When an administrator at an
institution of higher education (including faculty) has actual knowledge of a
suicide attempt on the part of an enrolled undergraduate2 97 student, or of
other circumstances indicating that the student is seriously suicidal, that
administrator has a duty to take reasonable steps to protect the student from

selfharm, including, but not limited to, notifying the student's parent/s or
guardian or reporting the information to an administrator who has authority
to make such notification. This duty may extend to other reasonable steps to
protect the student's safety, such as contacting campus counselors or
campus security officers, who might have the authority to take custody of a
student presenting a danger to self or others. It may also include other
actions, depending upon what is reasonable under the circumstances. Under
this rule, the duty would be triggered by actual knowledge either of a suicide
attempt or of circumstances that a reasonable non-clinician 296. Jain, 617
N.W.2d at 296. 297. The scope of this Article is limited to consideration of
undergraduate students for reasons of the age of most undergraduates and
their peculiar vulnerabilities. It is not intended to express any opinion as to
whether such a duty might obtain with respect to graduate or professional
students. 298. An obvious example would be attempting to stop someone
from jumping out of a window or off of a bridge. Circumstances might suggest
other kinds of reasonable steps that could prevent disaster in a swiftly
developing situation. 2008] MARQUETTE LAW REVIEW would perceive as a
serious threat of suicide. Absent exigent circumstances, the duty normally
could be satisfied by notifying the student's parent/s or guardian of the
attempt or of the seriously suicidal situation. It might well be that the actual
authority to contact a student's family would rest with a particular campus
official, such as the dean of students-as, for example, at the University of
Iowa in the policy cited in Jain v. State."' In that event, another campus
administrator or faculty member could fulfill the duty by reporting the
information to that official. Many critics of this suggestion will undoubtedly
question the wisdom of family notification as a virtually automatic response.
Students suffering mental health problems often do not wish their families to
be contacted, and, if asked, will request that they not be.3 Therapists
counseling those students might not think it to be a wise course of action,
particularly where they perceive the family situation to be a major contributor
to the student's problems."' Yet at least one group of mental health providers
counsels that family members should always be contacted early in the
process where serious mental disturbance is involved and hospitalization may
be required. Their experience shows that families are much more
cooperative and helpful in agreeing to a recommended treatment plan when
they are brought in early, rather than when they are consulted only after
healthcare providers have taken perceived necessary drastic action.
Psychiatrist Hannah J. Solky and three co-authors3 3 say that a failure on the
part of campus mental health professionals to include parents actually
amounts to the assumption of 299. Jain, 617 N.W.2d at 296; see supra notes
87-94 and accompanying text (discussing Jain generally). 300. See, e.g., Jain,
617 N.W.2d at 295 (describing Sanjay's attempts to hide his difficulties at
school from his parents by talking about how much he enjoyed his classes
and characterizing college life as "awesome"); Sontag, supra note 8, at 94
("Elizabeth specifically asked that her parents not be contacted, M.I.T. officials
have said."). 301. See, e.g., Ann H. Franke, When Students Kill Themselves,
Colleges May Get the Blame, CHRON. HIGHER EDUC. (Wash., D.C.), June 25,
2004, at B18 (recommending that students' parents be contacted "unless
previously known indicators, like a history of child abuse, suggest that
parental notification would be harmful"); Hara Estroff Marano, The Pressure
from Parents, PSYCHOL. TODAY, Mar/Apr. 2004,
http://www.psychologytoday.com/ articles/pto-20040513-000005.html (noting
that some counselors advocate a "parentectomy" when overprotective

"helicopter parents" contribute to anxiety and other psychological problems

in their children). 302. Hannah J. Solky et al., Involving Parents in the
Management of Psychiatric Emergencies in College Students Far from Home,
36 J. AM. COLL. HEALTH 335 (1988). 303. These consist of a psychologist,
James E. McKeever, and two psychiatrists, Richard A. Perlmutter and Thomas
E. Gift. [91:625 SUICIDE ON CAMPUS an in loco parentis role, which is
inappropriate and more likely to lead to litigious action than is early
consultation. These counselors were talking about healthcare providers, not
college administrators. While not unsympathetic to a counselor's position,
this Paper does not take a position on the question of when an actual
counselor should consider a course of action that in some sense amounts to a
breach of confidentiality. Rather, the context under discussion concerns a
situation in which a college administrator has actual information that would
lead a reasonable non-clinician to think that a student presents a severe
suicidal threat. Although the administrator lacks the knowledge to determine
whether hospitalization is necessary or appropriate, there are steps the
administrator can and should take to prevent incipient self-harm. In emergent
circumstances, that may involve contacting persons with authority to act
immediately for the student's benefit, including the power to exert custodial
control. In any event, the administrator should contact the student's family,
or pass the relevant information along to a campus official who is authorized
to do so. Surely, a student who is in need of intervention is highly likely to
end up involving family members, anyway-if for no other reason than
purposes related to insurance, or perhaps to co-pays. It stands to reason that,
as Solky and her colleagues found, parents who are alerted early are in a
much better position to cooperate with campus counselors and other
personnel in any way possible. Even a determination that the student needs
the kind of care that can be provided only off-campus-whether involving
outside therapists or actual institutionalization-still does not necessarily mean
that the student will have to leave the community, or even withdraw from
school. Schools that are automatically suspending students, such as George
Washington did in the case of Jordan Nott, risk not only violating federal laws,
but also acting inimically to the student's best interests. It is far preferable to
alert the family to the fact that their undergraduate student is suffering
severe mental stress or disturbance than to call them in at the point of
involuntary commitment, when the parents may be the only persons legally
situated to make certain kinds of decisions.3 4 To those who say that such a
policy might discourage campus 304. Every state has statutory mechanisms
for healthcare decision making for patients who are unable to make
responsible decisions for themselves. In the case of an unmarried adult son or
daughter (of any age), the designated person would be the child's parent,
unless the patient had executed a legal document specifying someone else.
See, e.g., Virginia's Health Care Decisions Act, VA. CODE ANN. 54.1-2986
(2005). 20081 MARQUETTE LAW REVIEW administrators from counseling
students in a nurturing and supportive way, there are several answers. First,
with respect to at least some campus administrators, such as a dean of
students or a housemaster, that is their job. Just as a healthcare professional
can potentially be sued for medical malpractice for the allegedly negligent
treatment of a suicidal patient, so it is appropriate for non-clinicians to be
subject to a negligence standard for failure to take reasonable steps to
prevent a student's self-harm, when they are on actual notice of such a
danger. Note, moreover, that in the reported cases, the campus personnel
involved could not escape the knowledge they possessed. Nina DavisMillis

was approached by Elizabeth Shin's frightened friends when the student held
a knife to her chest; the housemaster could neither avoid nor ignore that
information. She was later presented with the warning from two students that
Elizabeth intended to kill herself that day. She also spoke by telephone to
Elizabeth, who delivered a troubling warning: "you won't have me to worry
about any more."36 The security police and others at Ferrum College were
pressed by Crystal, Michael Frentzel's girlfriend, who told them of his suicidal
messages to her and others.3 7 Similarly, campus personnel found it
necessary to intervene in an argument between Sanjay Jain and his girlfriend
over the moped he had placed in his room for purposes of inhaling the
exhaust fumes; earlier, the hall coordinator had found it necessary to
discipline Sanjay on several grounds suggesting mental and emotional
disturbance. 3 0 Conscientious campus personnel will, I predict, continue to
nurture and support the students with whom they come in contact. The
increasingly widespread adoption of campus-wide programs to make both
students and administrators aware of mental health issues, particularly
suicide, should also help to dispel a sense of avoidance in order to escape
liability.' The arguments of Solky et al. that a failure to notify family
members of a suicide attempt or seriously suicidal behavior actually amounts
to usurpation of an in loco parentis role will not be convincing to everyone,
305. See, e.g., Marshall v. Klebanov, 902 A.2d 873, 881-82 (N.J. 2006)
(holding that statute shielding mental healthcare practitioners from civil
liability for the violent acts of their patients did not bar suit for alleged
negligence in treating patient who later committed suicide). 306. See Shin
Brief, supra note 15, at 5. See generally, supra notes 8-11 and accompanying
text. 307. See supra notes 276-84 and accompanying text. 308. See supra
notes 288 and accompanying text. 309. See supra notes 251-58 and
accompanying text. [91:625 SUICIDE ON CAMPUS but I think it provides much
food for thought. Both psychologists and commentators from other fields
have commented recently that our society has taken individualism to such an
extreme as to be harmful; we are in danger of forgetting that we exist, after
all, in subsystems, the most important of which is usually the family, and
family members are likely to be involved to some degree whenever one of
their group is seriously ill.31 In the typical family situation (whatever strains
might be at issue), parents are heavily invested in their college student's
welfare. These students are still highly vulnerable and not yet fully mature."'
It only makes sense to alert parents when an undergraduate son or daughter
is seriously suicidal. VIII. APPLICATION OF THE PRINCIPLE TO CASES A major
complaint about development of a doctrine that would pin a duty on college
administrators in some situations involving seriously suicidal students is that
such a duty is potentially indeterminate in scope. Critics ask: How would it be
triggered? How would a college administrator know that he or she was in the
kind of "special relationship" with a student that would meet the definition of
such a duty? How can the non-clinician administrator with no medical
expertise determine that a student is "seriously suicidal"? What would the
duty consist of-i.e., what steps would the administrator have to take in order
to be sure that his or her behavior was non-negligent? How would the actor
know when the duty was fulfilled?312 In many respects, these questions
represent objections to the shortcomings of Judge McEvoy's opinion 13 more
than they do valid criticisms of the potential workability of a rule of law that
would hold non-clinician administrators to a duty of reasonable care in some
instances of interaction with seriously suicidal students. I have suggested
that the college actor must have actual knowledge of the student's serious

condition (though note that this may result from the 310. See, e.g., KAY
REDFIELD JAMISON, NIGHT FALLS FAST 259 (1999) ("Almost inevitably, family
members and friends are drawn into the ... world of possible suicide.");
PAVELA, supra note 4, at 95 ("Experience has shown that families usually
come together in a crisis. . . . [College employees' relationships with a
student are] no substitute for the knowledge, insight, and devotion of the
student's parents."). 311. See supra Part IV (discussing this age group's
psychological development and brain maturation). 312. See Mass. Colleges
Brief, supra note 13, at 20-30, for a particularly detailed exposition of these
concerns. 313. See Shin v. MIT, No. 02-0403, 2005 WL 1869101 (Mass. Super.
June 27, 2005) 20081 MARQUETTE LAW REVIEW reports of others, such as
friends or girlfriends/boyfriends). The knowledge must be such as to alert a
reasonable non-clinician to the possibility that the student is seriously
suicidal. An attempted suicide would surely trigger such knowledge, but there
could be other indications that the student appears likely to be harboring
current suicidal intentions. The duty may most often be discharged by
notification of parents or a guardian about the situation. If the circumstances
would appear to the reasonable person to be emergent, the administrator
should take further reasonable steps to prevent any self-harm. It is important
to keep in mind that the issue concerns what kinds of fact patterns would
make out a prima facie case that a judge would send to a jury for a finding of
negligence. The ultimate conclusion, of course, is always in the jury's hands.
An examination of the primary cases discussed in this Article may make the
relevant criteria more concrete. In Schieszler v. Ferrum College, Michael
Frentzel's girlfriend was insistent in her dealings with college personnel that
Michael was seriously contemplating suicide and intervention was required to
save him.314 Campus authorities responded to one call where Michael
appeared to be trying to kill himself. The dean of student affairs asked him to
sign a statement that he would not harm himself-an obvious sign that the
dean thought such a danger existed.315 After Michael hanged himself, his
aunt and guardian was indignant that she had not been called in to help
Michael before it was too late.316 Judge Kiser found that this series of events
made out a prima facie case of a violation of a duty of care on the part of
Ferrum College personnel,317 and I would agree. The situation-including the
interactions between the dean of students and the student-was certainly
sufficiently specific to put the dean on notice of a duty to take reasonable
steps to prevent imminently threatened self-harm. At a minimum, contacting
Michael's guardian would have been a simple step and might have prevented
a tragedy. Unlike Michael Frentzel, Elizabeth Shin had been in therapy with
MIT counselors for quite some time when her suicidal threats seemingly
became dire. Her past history, including at least one suicide attempt, was
familiar to at least some MIT administrators. Under the 314. Schieszler v.
Ferrum Coll., 236 F. Supp. 2d 602, 610 (W.D. Va. 2002). 315. Id. at 605. 316.
Jen McCaffery, Lawsuit Raises Issue of Colleges' Accountability, ROANOKE
TIMES, (Roanoke, Va.), Aug. 25, 2002, at B1 ("Hell, they airlifted him from
Ferrum to Roanoke .... Somebody can't pick up the phone?"). 317. Schieszler,
236 F. Supp. 2d at 610. [91:625 SUICIDE ON CAMPUS circumstances, when
two of her friends anxiously reported to Nina Davis-Millis that Elizabeth had
stated her intention to kill herself that day, Davis-Millis's alarmed telephone
call to Arnold Henderson was appropriate. Assuming that the housemaster's
testimony was accurate, Henderson's failure to mention the apparently
developing situation at the "deans and psychs" meeting that morning surely
would support a prima facie case of negligence, under the rule proposed

here. One of those two administrators should have taken active steps to
prevent the potential for self-harm on Elizabeth's part. I would argue,
however, that the Shins should have been notified of Elizabeth's condition
before that Monday-at least, after her friends found her with the knife, which
they took away from her. Parental notification at that point, permitting the
Shins to adopt an active role in their daughter's treatment, would have
fulfilled the administrators' duty. As it is, both they and Elizabeth's parents
are forced to live with a very sad question mark. The circumstances of Sanjay
Jain are less definitive, but might be sufficient to pose a jury question. Beth
Merritt, Sanjay's hall coordinator, knew both that he was having adjustment
problems in college and that he was actively contemplating suicide and had
taken steps toward that end by placing the moped in his room. On the other
hand, Sanjay assured Merritt that he would discuss matters with his parents
over Thanksgiving break. She, for her part, discussed the situation with her
supervisor, David Coleman, while at the same time telling him that she
thought Sanjay was more tired than hopeless or despairing.318 It appears
from the reported case that it was his job to convey the information to the
dean of students, who would then determine whether to notify Sanjay's
parents." 9 The dean never received this report.32 Though I would argue that
an attempt or serious threat of self-harm should be reported to parents, I do
find this case one of finer line-drawing. The law, however, draws these lines
all the time; the difficulty of the enterprise does not negate the necessity of
engaging in it. Chuck Mahoney's parents should also have been brought into
their son's treatment process, given that he had been considered "a high risk
for suicide" for some time before his final act.3"2' In that case, Judge 318.
Jain v. State, 617 N.W.2d 293, 295-96 (Iowa 2000). 319. Id. at 296. 320. Id.
321. Mahoney v. Allegheny Coll., No. AD 892-2003, slip op. at 5 (C.P. Crawford
County, Pa. Dec. 22, 2005) (statement of Jacquelyn S. Kondrot, Chuck's
longtime counselor and head of the Allegheny College Counseling Center).
2008] MARQUETTE LAW REVIEW Barry F. Feudale found that the two
defendant deans had been consulted only a few days before Chuck's suicide,
making the case more similar to Jain than to Schieszler or Shin. That may be
an accurate assessment, but if a "special relationship" rule were a generally
operative tort principle, Chuck's situation might well have taken a different
and happier course. IX. CONCLUSION Suicidal ideation and behavior among
college students has been a matter of increasing concern over the past
decade or more. Because of federal privacy laws, parents of these students
are frequently kept in the dark about their student's troubled mental state,
even though friends and college personnel may have been well aware of it for
some time. In recent years, several lawsuits have garnered wide publicity
that seem likely to lead to a long-overdue amendment to FERPA, specifically
authorizing institutions of higher learning to contact the parents or legal
guardian of a suicidal student. That change, however, is not sufficient. In
addition, states should follow the lead of the judges in Schieszler v. Ferrum
College and Shin v. MIT in carving out a principle of a "special relationship,"
pursuant to Restatement of Torts (Second) section 314A or Restatement of
Torts (Third) section 40, triggering a duty, when a college administrator has
actual knowledge of a suicide attempt on the part of an enrolled
undergraduate, or of other circumstances that the student is seriously
suicidal, to take reasonable steps to protect that student's health and safety.
Such a duty should entail, perhaps among other things, a duty to contact the
student's parent/s or legal guardian, or to notify the appropriate college
official who would be authorized to do so. In some circumstances, a

coordinated plan of care, worked out among college counselors,

administrators, and the student's parents might even forestall harm, not only
to the student himself or herself, but to others as well. [91:625

Suicide Prevention
The college years are a time of great growth and development. College years are also a
time of stress. At the same time a student is assuming many of the responsibilities of
adulthood, the support structures that sustained the student through childhood may be less
available. The college age group is the period when several mental illnesses first appear,
including major depression. Suicide is the third leading cause of death among people age
15-24 (after accidents and homicides). The risk is actually somewhat lower for people in this
age group who are attending college than for those who are not attending college.
Most college students who commit suicide are suffering from depression -- diagnosed or not.
Therefore, by detecting depression as soon as possible and by providing support and
treatment, we can greatly reduce the likelihood of suicide among college students. The

following information is intended to help the community recognize warning signs and
worrisome behaviors.

Behavioral Signs of suicide risk

A person might be at risk for suicide if showing any of the following signs (from American
Association of Suicidology):

Talks about committing suicide

Has trouble eating or sleeping

Experiences drastic changes in behavior

Withdraws from friends and/or social activities

Loses interest in hobbies, work, school, etc.

Prepares for death by making out a will and final arrangements

Gives away prized possessions

Has attempted suicide before

Takes unnecessary risks

Has had recent severe losses

Is preoccupied with death and dying

Loses interest in their personal appearance

Increases their use of alcohol or drugs

Comments made by Someone Considering Suicide

Research shows that most (70%) of people who commit suicide have given warnings to
others in some form. Warnings might include statements like

Sometimes I wish I were dead

People would be better off without me

Would you like to have my [valuable possession]. I won't be needing it.

I'm not sure life is worth living

Hopefully I won't be around to find out ...

You [or boyfriend or girlfriend or family] will be sorry when I'm gone

I've lost hope

You can't understand how I feel

Nobody can possibly understand how upset I am

I can't imagine ever feeling better

If you are feeling suicidal

Recognize that you are suffering from a treatable illness. Suicide is a permanent,
irrevocable solution to a temporary problem. Talk to someone right away. Seek help from a
friend, a professor, an RA, an advisor, a coach, or anyone else you know.

What You Can Do

Here are some ways to be helpful to someone who is threatening suicide: from
American Association of Suicidology

Be direct. Talk openly and matter-of-factly about suicide.

Be willing to listen. Allow expressions of feelings. Accept the feelings.

Be non-judgmental. Dont debate whether suicide is right or wrong, or feelings are good or
bad. Dont lecture on the value of life.

Get involved. Become available. Show interest and support.

Dont dare him or her to do it.

Dont act shocked. This will put distance between you.

Dont be sworn to secrecy. Seek support.

Offer hope that alternatives are available but do not offer glib reassurance.

Take action. Remove means, such as guns or stockpiled pills.

Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Consult Someone who can Help: Involve other people

If you are concerned that a student may be suicidal, consult with an advisor, professor,
coach, resident assistant, Student Health, Public Safety, Campus Ministry or
University Counseling Center. You may be afraid your friend about whom you are concerned
will feel "betrayed" by your sharing your concern with anyone. Realize that the person
NEEDS help and cannot make a good judgment about seeking help. If the person is angry
at you, that is a small price to pay in order to save someone's life.

Common Misconceptions
From Suicide Awareness Voices of Education "SAVE"
1. "People who talk about suicide won't really do it."
Not True
Almost everyone who commits or attempts suicide has given some clue or warning. Do not
ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way
out," -- no matter how casually or jokingly said may indicate serious suicidal feelings.

2. "Anyone who tries to kill him/herself must be crazy."

Not True
Most suicidal people are not psychotic or insane. They must be upset, grief-stricken,
depressed or despairing, but extreme distress and emotional pain are not necessarily signs
of mental illness.

3. "If a person is determined to kill him/herself, nothing is going to stop him/her."

Not True
Even the most severely depressed person has mixed feelings about death, wavering until the
very last moment between wanting to live and wanting to die. Most suicidal people do not
want death; they want the pain to stop. The impulse to end it all, however overpowering, does
not last forever.

4. "People who commit suicide are people who were unwilling to seek help."
Not True
Studies of suicide victims have shown that more then half had sought medical help within six
month before their deaths.

5. "Talking about suicide may give someone the idea."

Not True
You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true
--bringing up the subject of suicide and discussing it openly is one of the most helpful things
you can do.

Article 4
www.ccsenet.org/ass Asian Social Science Vol. 7, No. 7; July 2011 30 ISSN
1911-2017 E-ISSN 1911-2025 Perception of Suicidal Attempts among College
Students in Malaysia Cai-Lian Tam Jeffery Cheah School of Medicine and
Health Sciences Monash University Sunway Campus, Malaysia E-mail:
tam.cai.lian@med.monash.edu.my Teck-Heang Lee (Corresponding author)
School of Business, Monash University Sunway Campus, Malaysia E-mail:
lee.teck.heang@buseco.monash.edu.my Wai-Mun Har Faculty of Accountancy
& Management Universiti Tunku Abdul Rahman (UTAR), Malaysia E-mail:
harwn@mail.utar.edu.my Li-Chuin Chan Department of Psychology, School of
Health and Natural Sciences Sunway University College, Malaysia Received:
January 12, 2011 Accepted: March 23, 2011 doi:10.5539/ass.v7n7p30
Abstract Teenage suicide has become a very serious problem and has been
labeled as a growing epidemic by many health professionals worldwide.
Through a questionnaire survey, the study aims to examine gender difference
in public perceptions on various reasons for and methods used in suicidal
attempts among teenagers. 90 college students participated in this study.
The results showed a significant difference among males and females for the
reasons why teenagers attempt suicide. The reasons were secularism, poor
parent-child relationship and atheism. For the methods of suicidal attempts, a
significant gender difference was also obtained for the slit wrist method.
Keywords: Suicidal attempts, Teenagers 1. Introduction Teenage suicide,
unfortunately, occurs in every corner of the world. It is a very serious problem
and has been labeled as a growing epidemic by many health professionals
worldwide. In Malaysia, the rate of suicide is alarming. According to the report
of a local newspaper in Malaysia, Nanyang Siang Pao (2010), there was 445
suicidal cases (347 males and 98 females) reported for the first eight months
of 2010 as compared to 290 cases in 2008. This accounts for the generally
higher record of suicide attempts in males than females in the Malaysian
context. In addition, the rates for those of 30-39 years (109 cases) and 20-29
years old (108 cases) was significantly higher compared with other age
cohorts. The report further revealed that suicidal acts are culture-bound. Most
cases have been linked to suffering from perceived burdensomeness which
includes emotion, study and work (Nanyang Siang Pao, 2010). Suicide occurs
throughout the world in different ways. Various studies have been conducted
specifically to examine the relationship of suicidal behavior and the rates of
suicidal attempts with the demographics factors such as the sex/gender,
race/ethnicity, age, and marital status. Generally, in the U.S, males as a
group successfully commit suicide more than three times compared to the
females (Williamson & Shneidman, 1995). It is also found that suicide is more
rampant and common among youngsters. Such a finding may due to the
different life situations and motives in life among the youngsters, adults and
the elderly (Portes, Sandhu & www.ccsenet.org/ass Asian Social Science Vol.
7, No. 7; July 2011 Published by Canadian Center of Science and Education 31
Longwell, 2002). As statistical evidence prove that suicidal behaviors is more
rampant among youngsters, this extensive occurrence among youngsters is
indeed explained by Erik Eriksson who indicated the importance of social
surrounding in an individuals overall mental development. Suicide is said to
occur due to the failure to master the Erikssons eight developmental stages
(Portes, Sandhu & Longwell, 2002). Eriksson asserts that during adolescence,

the adolescents undergo the process of resolving the issue of identity versus
confusion. During this period of time, they undergo the search for their own
identity through sexual, social, ideology and career domain (Portes, Sandhu &
Longwell, 2002). Therefore, by the means of Erikssons theory on
development the undercurrent reason for the occurrence of suicide among
the youngsters can be explained. Depressions among youngsters due to their
inability to find their identity results in the emergence of suicidal behavior
and causes them to react destructively to situations without being able to
understand the situation. Besides, various studies as highlighted in section
2.1 of the paper indicated that gender differences have made a distinction
between suicide attempts and completion, with consideration of actual
motives behind such acts. Hence, the findings of this study in turn contribute
towards understanding the mental setting of individuals who have attempted
suicide, in comparison with intact people and their level of motivation. This
implies that suicide intervention should be customised according to
adolescents gender, needs, personality, social environment and other
relevant factors (Shain, 2007). Besides, through the present study, it would
also raise the awareness of the society that more research is required since
information on suicide ideation and non-fatal attempts are only obtainable via
self-reports which are subject to numerous influencing factors such as
cognitive decline and repression thus lowering its reliability over time (Cantor
& Neulinger, 2000). The present study also aim to gain further understanding
of the reasons behind suicidal attempts as well as the opinions of individuals
in regards of suicidal methods and interventions. 2. Literature Review For the
purposes of this study, suicide will be defined as an intentioned death. It also
refers to a self-inflicted death in which one makes an intentional, direct, and
conscious effort to end the life of a person (Comer, 2004). A suicide attempt
is defined as any self-injurious behavior with a nonfatal outcome irrespective
of intention (De Wilde, 2000 cited in Pelkonen & Marttunen, 2003). This
brings up a few interesting questions. Do male and female teenagers who
attempt suicide do so for different reasons? What about the ways in which
they attempt to kill themselves? Are they similar or very different? 2.1
Reasons of suicidal attempts and gender differences There are many factors
contributing to the frequency of suicidal attempts such as hopelessness,
personal history of depression and aggressive behaviour, use of alcohol and
drugs, family-, school- and peer-related problems, unemployment, and a
family history of suicidal behaviour (Wagner, Cole, & Schwartzman, 1995; Al
Ansari et al., 2001). An individuals socioeconomic status can also influence
suicidal attempts. Individuals with low income tend to commit suicide more
often than better paid individuals (Boxer, Burnett, & Swanson, 1995). In
developing countries, low socioeconomic status is believed to be the main
cause of suicide. Another reason why younger people are attempting suicide
is because of a loss of a sense of hope and a loss of a sense of the future
(Brown, 2001). As times are rapidly changing, teenagers experience a lot of
confusion and uncertainty about their future. Research also indicates that
suicidal rates are lower in countries that have a negative point of view about
suicide and higher in countries that are less negative in their view of suicide
(Kelleher et al., 1998; Lester, 1996, 1998; Neeleman, 1998; Neeleman et al.,
1997). Suicidal thoughts and behaviours among friends and family are also
important factors that can influence teenagers to attempt suicide. Marui,
Rokar, and Hughes (2004) studied Slovenian adolescents and found that
13% of the teenagers had a family member who had attempted suicide, 9%
lost a family member as a result of suicide, and half of the females and one

third of the males had suicidal thoughts before actually attempting suicide.
As teenagers are easily influenced, they might decide to model the behaviour
of the people closest to them or those whom they admire. In Taiwan (Cheng,
1995; Cheng et al., 2000), China (Phillips et al., 2002), and India (Vijayakumar
& Rajkumar, 1999), several research demonstrated a relationship between
mental illness and suicidal attempts. According to Stolberg et al. (2002 as
cited in Comer, 2004), the majority of all suicide attempters displayed a
psychological disorder. Brown (2001) found that suicide rate amongst
substance abusers are 12 times that of the general population. In addition, it
is also suggested that people who are diagnosed with depression are 22-36
times more www.ccsenet.org/ass Asian Social Science Vol. 7, No. 7; July 2011
32 ISSN 1911-2017 E-ISSN 1911-2025 likely to kill themselves. This rate is
disturbing as more and more young people are diagnosed with depression
and other mental disorders. It is likely for one to assume that women are
more emotional compared to men and therefore, the rates of suicidal
attempts would be higher among females. Indeed, it has been found that
women do attempt suicide three times more than men. Nevertheless, men
succeed at killing themselves three times more than women (Maris, 2001 as
cited in Comer, 2004). It is interesting to note that in China, womens suicide
rates are 25% higher than men (Phillips, Li, & Zhang, 2002) and in India this
rate is equal among males and females (Mayer & Ziaian, 2002). On the other
hand, in India (Mayer & Ziaian, 2002; Rao, 1991), Pakistan (Saeed et al.,
2002), China (Phillips, Li, & Zhang, 2002), Brazil (Souza, Minayo, & Malaquias,
2002), and Nigeria (Nwosu & Odesanmi, 2001) young men are found to be at
a higher risk of suicidal attempts. There are a few studies which have
demonstrated differences in the reasons for and methods used to attempt
suicide. For example, Hjelmeland and Grholt (2005) conducted a study on
attempted suicides with 98 subjects, 86 of them females and 12 of them
males. The subjects were all patients at various hospitals in Norway. Relevant
information regarding the attempted suicide was obtained via interviews and
questionnaires. 69 of the subjects stated that feelings of loneliness was what
had driven them to attempt suicide while the other precipitating factors were
mental illness, problems with partner, and rejection by lovers. Groohi et al.
(2006) conducted a study on suicidal behaviour by burns amongst
adolescents in Kurdistan, Iran. They had 40 subjects, 34 of them females and
6 of them males, who were admitted into the hospital because of burn
injuries. Relevant information was obtained from the adolescent or significant
others (e.g. parent, relatives, friends who know the adolescent well). For the
majority of the subjects (18), they attempted suicide because of a quarrel
with a family member (e.g. parents, brothers, sisters or mother-in-law). The
second most frequent reason that caused them to attempt suicide was due to
marital conflict. The remaining reasons were conflict with spouses relatives
and having a psychiatric disorder. 2.2 Methods a of suicidal attempts and
gender differences One of the reasons for the difference in suicide rates
between genders could be due to the fact that men and women choose
different methods (Ayd & Palma, 1999 as cited in Comer, 2004). This could be
due to the accessibility of certain means. For example, young women in
villages in China use strong, concentrated pesticide which can be found in
their refrigerators while young men in industrialized nations use guns (Brown,
2001). In a study conducted on 374 Slovenian juveniles (39 boys, 335 girls)
who attempted suicide, Krajnc et al. (1998) found that almost all the subjects
had attempted suicide by taking an overdose of drugs (98.4%). The
remainder attempted suicide by taking an overdose of alcohol. The most

common reason offered by the suicide attempters were despair due to

disturbed relationships within the family (38%). Another 21% attributed the
attempts to disappointments, usually in love. Poor school performance
accounted for 18% of the suicide attempts (Krajnc et.al., 1998). According to
Beautrias (2003), the lethality theory posits that males with their tendency to
be more aggressive and conformation to the traditional masculine
stereotype, prefer to perform suicidal acts with methods of high and
immediate lethality in comparison to females. This has been suggested to
contribute to elevated male suicide rates. Moscicky (1994) rejected this
theory, stating that there is no consideration of an intention to die and selfinjury as a potential indicator for help. In agreement, Canetto and Sakinofsky
(1998) believe that suicide intent is distinct from the chosen method and is
unreflective of the outcome. Individuals may not survive from acts thought to
be non-fatal (i.e. drug overdose) while others may survive a seemingly fatal
act (i.e. car crash). It was concluded that despite the influence of method
lethality on gender differences in mortality, most female suicide attempts
have non-fatal motivations unlike male counterparts. Nevertheless, Beautrais
(2003) found that suicide method choice can explain gender disparities in
outcome of more serious suicide-attempting youths. 2.3 Ways of preventing
suicidal attempts Based on the above evidences discussed in section 2.2 and
2.3, it is clear that there are various factors that may instigate a suicide
attempt. Moreover, there seems to be cultural influences as well, with
different countries having different factors as the main cause. Instead of just
focusing on the negative issues, lets look at the brighter side and figure out
what can be done to prevent suicide attempts. Some studies have offered
some intriguing answers. A study was conducted on 2722 adolescents by
Flouri and Buchanan (2002) and they found that parental involvement (e.g.
direct interaction with the child, availability to the child, and responsibility for
the care of the child) is a protective factor as it seems to prevent suicide
attempts. Religion also seems to play a part in preventing suicides. It has
been noted that Islamic www.ccsenet.org/ass Asian Social Science Vol. 7, No.
7; July 2011 Published by Canadian Center of Science and Education 33
countries tend to have one of the lowest suicide rates in the world (Brown,
2001). This could be due to the fact that Islam fervently condemns suicide.
2.4 Objectives and hypotheses of study The current study focuses on the
college students point of view about teenage suicide: its reasons, methods
and possible ways of preventing it. In this study, the definition of teenagers is
defined as any individual between the ages of 13 to 20 years. The aims of the
study are to find out whether there is gender differences exist in the
participants perceptions of the reasons for suicidal attempts in males and
females, and the methods used by both genders to attempt suicide. Due to
interest, we also intend to find out what were the participants perceptions of
the best ways to prevent suicide attempts amongst teenagers. The
hypotheses of the study are: H1: There would be gender differences in the
reasons for suicidal attempts amongst males and females. H2: There would
be gender differences in the methods used in suicidal attempts amongst
males and females. 3. Method 3.1 Respondents The respondents of this study
were 90 college students, 45 males and 45 females. Their age ranged from
18 20 years and the mean age of the participants was 19.46 years. There
were 11 Malays, 52 Chinese, 6 Indians, and 21 who were of other races. 89
respondents were single and only one was married. There were 30 Buddhist
12 Islam, 31 Hindu, 9 Christian and 8 of others. Forty five respondents had
their highest education level at SPM or equivalent, 6 at STPM, A-Levels, or

equivalent, 13 at diploma, and 26 at undergraduate program. All respondents

agreed to take part in the survey voluntarily. 3.2 Measurements The
questionnaire used was a self-constructed questionnaire. The questionnaire
consisted of 3 parts that measured publics perception on reasons for suicide
attempts, methods of suicide Attempts and ways to prevent suicidal
attempts. The questionnaire of this study is available in the appendix. 3.2.1
Publics Perception: Reasons for Suicide Attempts There are 13 items for the
inventory. Participants are required to rank the reasons for teenage suicide
attempts from 1-most frequent to 13-least frequent. Participants had to rank
the reasons for both male and female based on their own opinions. 3.2.2
Publics Perception: Methods of Suicide Attempts There are 9 items for the
inventory. Participants are required to rank the methods teenagers use for
suicide attempts from 1-most frequent to 9-least frequent. Participants had to
rank the methods for male and female based on their own opinions. 3.2.3
Publics Perception: Ways to Prevent Suicidal Attempts There are 6 items for
the inventory. Participants are required to rank the best way to prevent
teenage suicide attempts from 1- most important to 6-least important.
Participants had to rank the best way for prevention according to their own
opinions. 3.3 Procedure The survey was conducted in a private college in
January 2008. Participants were required to fill in a consent letter to show
that they agreed to take part in the study. Participants were allocated an
average of 30 minutes to answer the questionnaire and all were returned
upon completion. 4. Results Reasons of Suicide Attempt between males and
females were analyzed to find out if there was a gender difference regarding
the way subjects viewed factors that influence male and female suicides.
Research revealed that, t (88) = -2.887, p

They may not call it cyberbullying. Students may say they got "dissed" on Facebook or that
someone flooded their phone with mean texts. Even little kids have been known to hack into Club
Penguin to sabotage each other's games.
While most of these incidents occur at home, the problems spill over to the classroom, making
cyberbullying an issue teachers can't ignore.
The answer isn't forbidding technology, say experts, so much as teaching kids right from wrong.
As a teacher, you can be a powerful force in promoting a climate of respect. Educate yourself and
be on the lookout for signs that cyberbullying is taking place, because you may be the trusted
adult a student turns to for help.
How to Recognize It
A lot of innocent teasing happens on Facebook and via text message. So when does a good joke

go bad? When someone "repeatedly harasses, mistreats, or makes fun of another person," say
Sameer Hinduja and Justin Patchin, co-directors of the Cyberbullying Research Center.
In their research, the two academics found that approximately 20 percent of students admitted to
having cyberbullied. However, many more students reported incidents that fall under its definition.
Posting mean or hurtful comments and spreading rumors online was the most common complaint
in their random survey of 4,400 students ages 10 to 18 in February 2010.
Not surprisingly, it is most prevalent among middle schoolers, and adolescent girls are more likely
to have experienced cyberbullying than boys 25.8 percent versus 16 percent. Girls are more
likely to spread rumors, while boys are more likely to post hurtful pictures or videos.
"Cyberbullying is tailor-made for the relational aggression and rumors that girls typically engage
in," says Patchin, associate professor of criminal justice at the University of Wisconsin-Eau Claire
and co-author with Hinduja of Bullying Beyond the Schoolyard: Preventing and Responding to
Cyberbullying.
While research shows that cyberbullying makes both boys and girls feel angry, sad, and
embarrassed, girls are more likely to react with frustration "Why doesn't anyone like me?"
while boys are more often scared, perhaps of back alley retribution. And as we all know from
recent headlines, in the most extreme cases, cyberbullying can trigger violence or suicide.
It's also different from traditional bullying in challenging ways. The bully can remain anonymous
and unaware of the pain inflicted on the target. Middle school kids who are just learning to
navigate the social scene may not realize how hurtful online comments can be.
"It emboldens some kids to bully who wouldn't otherwise, because they can hide behind a
computer screen," says Patchin. Most disturbing is the lasting impact of cyberbullying. Once
something goes viral, the harassment is continuous because it is shared, repeated, and nearly
impossible to erase.
Schools Stepping Up
School is the center of kids' lives. Online harassment may take place on nights and at home, but
the fallout is often seen at school and can interfere with the educational environment. In the worst
case, students are so worried about cyberbullying that they can't focus on their studies or are
afraid to come to school. It has become a school climate and safety issue.
"Monday is the new Friday," says Nancy Willard, director of the Center for Safe and Responsible
Internet Use in Eugene, Oregon. "It used to be that hurtful interactions built up over the week and
would blow up on Friday. Now when kids go back to school on Monday, they are upset because
of what happened online over the weekend. There's no longer time to calm down."
There is a flurry of activity in states to make tougher cyberbullying laws, but, "It's not something
you can legislate or arrest your way out of," cautions Stephen Balkam, chief executive officer of
the Family Online Safety Institute in Washington, D.C. "It's always going to be a combination of
tools, rules, and schools. The emphasis needs to be on creating a culture of responsibility online.
Kids need to think about the content they create and post."
Schools are struggling to create policies that deal with cyberbullying and the use of cell phones at
schools. Experts say banning technology is not the answer, but rather teaching kids to be good
digital citizens. When schools adopt codes of conduct, they should apply to activity in or out of
school and set the consequences up front. The notion that home and school are two separate
spaces no longer exists in the minds of digital kids.
If schools are using technology to deliver education and instruction, they have a responsibility to
educate students so they use it correctly, says Hinduja. "Schools believe the Internet and
computers are part of kids' lives when honestly, it is their life," he says.

"Teachers should not limit the discussion to computer class or Internet safety day.... You should
bring it up in any capacity, in any instance, in any classroom, whether algebra or social studies or
the hard sciences."
First Step: Take It Seriously
The first step is to take it seriously, says Michelle Boykins, director of communications and
marketing for the National Crime Prevention Council. "It's not just kids being kids. We have to
make sure cyberbullying is not a rite of passage. If we don't change the culture then we are
helping young people be victimized."
Go online, get familiar with the social networking sites, slang, and terms, says Vicki Davis, a
teacher and IT director at Westwood Schools in Camilla, Georgia. "This is a world where they are
and we aren't," she says. It's important to emphasize a positive environment and explain what
won't be tolerated.
You have an ally in the school counselor, suggests Rosemary Kelly, director of guidance and
counseling at Round Rock Independent District Schools in Texas. Counselors have experience
teaching kids what it means to be kind, responsible, and respectful, and that translates to their
behavior online. They may need to hear the message that if you aren't going to say it to
someone's face, don't do it online, adds Linda Criddle, president of LookBothWays, a nonprofit
that provides information on Internet safety.
Perhaps the most important thing you can do is give kids ways to avoid victimization. Remind
them to "never put anything sensitive into an electronic format and send it to someone," says
Willard. "The more embarrassing or damaging the material you send electronically, the more
likely it will become public."
Finally, let kids know you care and want to help. If there is a problem, you will advocate for them,
not just punish them and take away technology. Experts suggest having an anonymous way to
report, such as a drop box, hotline, or e-mail, and tell students that reporting a cyberbullying
incident isn't squealing. "It's a misperception that wimps tattle," says Criddle. "Actually, kids who
come forward and tell are kids who said, I can't solve the problem myself but I deserve better.' "
Recognizing the Signs
Keep your finger on the emotional state of students. Does a student seem depressed?
Withdrawn? Are his grades suddenly dropping? Hang out in the hallways and lunchroom to look
for changes in relationships, such as a student cast out from her usual lunch table. With younger
kids, it may be that they have a stomachache or want to stay home.
In middle school, teachers may witness a spat erupting in the back of class. Once you ask the
students what happened, you may learn that the aggression started the night before online.
Know how to intervene when kids make social mistakes, says Kimberly Mazauskas, bullying
prevention coordinator for the School District of Palm Beach County (FL). Listen to them and
validate their feelings. Then, let the student know what's not right and guide to another
alternative.
Ask Students to Report It
Bullying stops when the bystanders speak up. Encourage bystanders to refuse to pass along
cyberbullying messages. Or they could add to a wall post "This is not cool" when they see
something inappropriate, says Davis.
Lori Devon Shapiro, special project assistant with the bullying violence prevention program in the
School District of Philadelphia, worries that schools are not being proactive enough. "The one you
miss could be fatal; that's the scariest part," she says. "If you continue to be reactive, you're going
to end up reacting to a situation that nobody wants to see themselves in."

Responding to an Incident
If you find out about cyberbullying incidents, pay close attention right after it happens. "That's the
only time to really get to the truth," says Davis. Later, everyone may get on the same page and
the target pressured to change the story.
Encourage the target of cyberbullying not to erase the evidence by immediately deleting the
hurtful message from her wall or phone. Tell the student to take a screen shot to save it, and then
share the information with an adult.
Break the myth that the bully is the cool one and it's the victim's fault, says Criddle. Ask students
why they were bullied and you'll hear them say they are too fat or too tall. Rather, it's the bully
who is hurting and wants to lash out and be mean, says Criddle.
Finding the Right Response
Although there should be consequences for cyberbullying, many experts say it should not be all
about punishment. Those who bully need to understand the impact of their actions, and they can
often benefit from counseling.
Listen to the students and let the target be part of the solution, suggests Willard. Often,
restorative justice techniques where students talk with each other to understand the impact of
the incident are effective.
Separate the behavior from the student, says Shapiro. "We try to take the criminalization out of it,"
she says. "It's a matter of teaching right from wrong and teaching them proper behavior, rather
than branding them a criminal forever."
Many states are attempting to pass laws that dictate punishment for cyberbullying, but Balkam
urges caution. "State legislatures have to be careful not to criminalize what is a form of
playground misbehavior," he says. "Do we really want our kids to do time for stuff we did as kids
but we put on notes and passed around the classroom?"
Getting Parents Involved
Schools are an important place to connect with parents and disseminate information about online
safety. Invite parents to workshops about cyberbullying and share the school's policy.
"Teachers have to encourage parents to be involved in their kids' online lives," says Hinduja.
"They're already involved in cheerleading or football. We have to be similarly passionate about
what kids are doing online."
Just as parents wouldn't let their kids run around an amusement park, they shouldn't let kids surf
online unsupervised, says Kelly. "I hear parents say, I don't know how to do this on the computer,
but my child knows everything.' That's dangerous territory."
Balkam adds, "It's a work of a generation; it will take our kids from now until they are parents and
teachers themselves to overcome this divide."

In the 1985 movie The Breakfast Club, five very different students spend a
day in Saturday detention. These students a brain, an athlete, a basket
case, a princess and a criminal find out that they all have different talents
and strengths and that each of them has something valuable to contribute to
the group (Hughes, 1985). All of us have had students who show different
strengths, like the characters in this movie, and good teachers have found
ways to let each of these students shine, based on their natural abilities. This
is the hallmark of using the multiple intelligences theory in the classroom
What is the MI theory?
Howard Gardner first published his MI theory in 1983, suggesting that
intelligence is not a single, static IQ number, but rather a dynamic collection
of skills and talents that are manifested differently in different people
(Gardner, 1983). The nine main types of intelligences are indicated in Figure
1. When teachers recognize that students bring varied talents into the
classroom, they can help students find success by allowing them to use their
natural intelligences. Teachers can find ways to build tasks into each lesson
that allow students to interact with the content in ways that fit their learning
styles and strengths.
Figure 1: Types of intelligences
Verbal-linguistic intelligence Well-developed verbal
skills and sensitivity to the sounds, meanings and

rhythms of words
Mathematical-logical intelligence Ability to think
conceptually and abstractly and capacity to discern
logical or numerical patterns
Musical intelligence Ability to produce and appreciate
rhythm, pitch and timbre
Visual-spatial intelligence Capacity to think in images
and pictures and to visualize accurately and abstractly
Bodily-kinesthetic intelligence Ability to control ones
body movements and to handle objects skillfully
Interpersonal intelligence Capacity to detect and
respond appropriately to the moods, motivations and
desires of others
Intrapersonal intelligence Capacity to be self-aware
and in tune with inner feelings, values, beliefs and
thinking processes
Naturalist intelligence Ability to recognize and
categorize plants, animals and other objects in nature
Existential intelligence Sensitivity and capacity to
tackle deep questions about human existence, such as
the meaning of life, why do we die and how did we get
here
Source: Concept to Classroom (2004).
How can MI be used to support students?
Supporting students both behaviorally and academically begins with meeting
their needs. By developing lessons that draw on a variety of different
intelligences, teachers can hope to better meet the needs of many more
students than through one method alone. Think of this: If you were asked to
do a task that was interesting and that you had confidence you could
complete successfully, how might you approach it? What kind of attitude do
you expect youd have toward the task? You would probably feel pretty good
about getting started and you most likely would be able to work until
completion without incident. Now, think of being asked to do a task that you
had little hope of completing, given your skills and talents. Would you
approach it with the same enthusiasm? Would you be able to stick with the
task without distraction? Most people would answer these questions,
probably not. Think about how many students are faced with the second
scenario on a daily basis. It must be very frustrating and is likely the cause of
many of the behavior problems we see in schools.

We can illustrate the successful use of MI in the classroom by going back to

The Breakfast Club characters. In the movie, the characters were asked to
write an essay explaining who they think they are (Hughes, 1985). This task
uses the strengths of verbal-linguistic intelligence and is something that
Brian, the brain, is comfortable tackling. However, the other four students
are not remotely interested in completing this assignment and the group
spends the day off task, vandalizing school property and participating in
several questionable behaviors. What if each student was to complete the
assignment in a different way? Claire, the princess, would likely enjoy the
essay if she could do a video essay of interviews with her fellow classmates.
This activity would use her interpersonal intelligence, which has also allowed
her to be successful in social clubs and popular with her peers. Andy, the
athlete, might be able to express his sense of self by giving a demonstration
of how he is able to defeat an opponent in wrestling. He could explain how he
uses strategy and specific moves that he can perfect due to his bodilykinesthetic intelligence to be the champion he is. Allison, the basket case,
demonstrates visual-spatial intelligence, so she might feel more motivated to
show who she thinks she is by producing a work of art. Finally, Bender, the
criminal, also demonstrates verbal-linguistic intelligence and interpersonal
intelligence, but he is a student who might need a bit more motivation to
complete the task. His teacher might ask him to give a speech on who he
thinks he is not, allowing him to use his verbal strength and also maintain his
need to be different. These examples would likely spark greater interest in
the students and might have kept them focused on the given task.
Of course, it is unrealistic to think that every teacher can individualize every
lesson for every student. In a typical class, there will be several students who
demonstrate strengths in each of the areas of intelligence, so allowing
students to work in cooperative learning groups, either mixing different
intelligence types or clustering them, depending on the assignments, may be
a successful strategy for teachers. Another option might be to offer two to
five choices of activities students can do to demonstrate their mastery of the
content. This would allow teachers less time for preparation and grading
assignments, but would still allow students to tackle their work using their
natural skills. Finally, teachers can develop lessons that incorporate several
different strategies, allowing students to gain some comfort with the work at
different stages of the class activity. Most people have strengths in several
different areas of intelligence, so they will be able to feel successful using a
variety of strategies. While thinking about differentiating lessons in these
ways may feel like additional work for teachers, the alternative may cause
more work over time. By allowing students to successfully show what they
know, teachers can avoid classroom disruption and minimize reteaching,
creating a more productive classroom environment for all.
What resources are available to help with using MI in the classroom?
Because MI theory has gained so much support in the field of education
(Almeida, et al., 2010; Koong & Wu, 2010; McCoog, 2010; Shearer, 2009;
Shearer & Luzzo, 2009; Small Roseboro, 2010), there are many print and
online resources designed to help teachers use MI in the classroom, such as
the following:

Concept to Classroom, Workshop: Tapping into multiple intelligences This

workshop takes teachers through the theory behind MI and provides
resources and ideas for using MI in the classroom.
Edutopia, How to address multiple intelligences in the classroom, by Sara
Bernard This website provides strategies, links and lesson plans for teachers
looking to use MI in the classroom.
Learning Technology Center III, Lesson Plan Ideas This site offers many
different ideas for projects and activities to use in the classroom which can be
aligned to each of the different intelligences.
New Horizons for Learning, Multiple Intelligences This website offers
articles, recommended reading, related links and critical questions pertaining
to MI theory.
This is just a small sampling of sites. For teachers who are interested in using
MI in their classrooms, spending some time searching for lesson plans, MI
inventories or quizzes, and other reading may be a good place to start. At the
very least, finding ways to encourage students to use their natural
intelligences will make lessons more productive, students more successful
and the classroom a more positive environment for everyone.
References
Almeida, L.S., Prieto, M.D., Ferreira, A.I., Bermejo, M.R., Ferrando, M., and
Ferrandiz, C. (2010). Intelligence assessment: Gardner multiple intelligence
theory as an alternative. Learning and Individual Differences, 20(3), 225-230.
doi: 10.1016/j.lindif.2009.12.010.
Concept to Classroom Workshop: Tapping into multiple intelligences.
Retrieved July 2, 2010,
from http://www.thirteen.org/edonline/concept2class/mi/index.html.
Gardner, H. (1983). Frames of mind: The theory of multiple intelligences. New
York: Basic Books.
Hughes, J. & Tanen, N. (1985). The Breakfast Club [Motion picture]. Universal
City, CA: MCA Universal Pictures.
Koong, C., and Wu, C. (2010). An interactive item sharing website for creating
and conducting on-line testing. Computers & Education, 55(1), 135-144. doi:
10.1016/j.compedu.2009.12.010.
McCoog, I.U. (2010). The existential learner. Clearing House: A Journal of
Educational Strategies, Issues and Ideas, 83(4), 126-128. doi:
10.1080/00098651003774828.
Shearer, Branton (Ed.). (2009). MI at 25: Assessing the impact and future of
multiple intelligences for teaching and learning. New York: Teachers College
Press.

Shearer, C.B., and Luzzo, D.A. (2009). Exploring the application of multiple
intelligences theory to career counseling. Career Development
Quarterly, 58(1), 3-13.
Small Roseboro, A.J. (2010). Teaching middle school language arts:
Incorporating twenty-first century literacies. Blue Ridge Summit, PA: Rowman
& Littlefield Education.