Responding to Students at Risk of Suicide – How Assertive is too Assertive?

Gerard HoffmanHead of Counselling ServiceVictoria University of Wellington

Paper presented at ANZSSA biennial conference Auckland New Zealand , December 2007

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Background

Series of completed suicides of students at Victoria past 5 years

Suicide Prevention working group formed -2004

VUW Mental Health Promotion and Suicide Prevention Plan (2005)

Responding to Suicidal Behaviour by Students Policy (2005)

Case study 1

Jon was a 21 year old young man living with his parents. He had been receiving counselling and medical treatment for chronic low mood for a period of almost one year. He had reported some suicidal thinking at several points in his treatment. He had been adamant that his parents were not contacted or involved in his counselling. One of the foci of counselling was his stated wish to individuate from his parents.

What would you do?

Case Study 2

Ned’s mother who lived in the South Island contacted the Wellington police late one night after receiving a disturbing phone call from her depressed son threatening to suicide by walking in front of a train. The police went round to his flat, took him back to the station and had him assessed against his wishes by the crisis team. The next morning he was referred for urgent follow up to the university counselling and health services. He refused all offers of follow up.

What would you do?

Case Study 3

Jenna was a 19 year old student living with her parents. She disclosed to her counsellor that she had made several serious suicide attempts in the past week, one by hanging. She remained at high risk and refused to agree for her parents to be involved in her care threatening to stop coming to counselling if we did this. After much discussion we decided that either she inform her parents of her situation (and provide us with evidence of this) or we would. She did, extremely reluctantly, talk to her parents, who made contact with us immediately. She refused to come back to counselling.

What would you do?

5 Step Model of Suicide

Intentionto die

(or not live)

Overcomeexternal

restraintsCrisis

Impaired cognitive

and emotional

state

Death by suicide

Vulnerability

Assertive Intervention with Suicidal People

Direct questions Active engagement and concern Active encouragement of help seeking Involvement of significant others Follow up of missed contact Education of significant others Taking charge when mental state

impaired Using legal mechanisms to ensure safety

Privacy Issues

Often mistakenly a barrier to sensible collaboration and information sharing

Health Information Privacy Code (NZ) governs the use of health information

Focus on organisations developing and informing clients of their privacy practice

Reason for obtaining and holding health information is key

Professional Associations Codes of Ethics re: confidentiality

Consent Issues

The principle of informed consent to health care

Unsolicited versus solicited information University staff have a duty of care to act

to ensure safety Laws and codes of ethics are often only a

guide to decision making Best practice is to seek consent at all

times and act collaboratively

Discussion

Ongoing discussion of this emotive and often polarising issue

Impact of suicide on staff influences their practice

Catastrophic impact of suicide justifies conservative practice

Balance rights of students versus need to protect our students and community

Engagement of vulnerable people in crisis Misinformation about issues of privacy

and consent Risk of complaint minor compared to

impact of suicide

A Way Forward: Sensible information Sharing and Collaborative Practice

1. Low threshold for referral to and between health services

2. Encouraging early non identified discussion of students of concern

3. Explicit Service Privacy Statements noting shared care and limits to privacy

4. Early and assertive involvement of significant others

5. Actively seeking consent to involve others and share information

6. Assertively contact students at risk7. Using staff and family to help engage reluctant

help seekers.8. Educating university staff on sensible privacy and

collaboration practices