This case involves a 19-year-old female college student who committed suicide in her dorm room in November of her sophomore year. The student had no history of mental illness prior to arriving at college and was physically healthy. A year before her death, the student sought out guidance from the college counseling center for stress management. Within the first month the student began seeing a counselor, she was put on anti-depressants. The counselor continued to increase the dosage of antidepressants over the course of the year, during which time the student developed worsening symptoms of anxiety and depression. On the night of her death, the student called the suicide hotline at the college and spoke with the psychologist on call. The student mentioned all her symptoms and verbalized that she was “at a low” and feeling suicidal. The school psychologist asked her to hold off until the next morning and asked the student to promise not to hurt herself. After getting off the phone, the student hung herself. An expert in suicide prevention with particular experience treating college-age patients was sought to review the case and determine whether the college was negligent in its suicide prevention protocol.
Question(s) For Expert Witness
- 1. Please describe your experience in treating suicidal students?
- 2. Are you familiar with the proper steps that should be taken as soon as student indicates suicidal tendencies?
- 3. Should a psychologists only action be to ask a student to hold off on committing suicide?
Expert Witness Response E-044983
I am a licensed psychologist and have extensive clinical experience working with this population. I previously worked in a university-based psychology clinic and with college students undergoing suicidal crises. I also have broad experience providing clinical services to adults in major psychiatric and medical hospitals. The bulk of my clinical training and experience has been in the assessment and treatment of patients experiencing suicidality. Previously, I worked extensively with such individuals as a member of a suicide crisis management unit at a large state university, in the psychiatric emergency room of an Ivy League medical school hospital, and in the psychiatric crisis units of various nationwide hospitals. In addition, I regularly provide suicide risk assessment and intervention training to graduate student and medical trainees as a part of my teaching responsibilities as an assistant professor in a university psychology department. In addition to my extensive clinical expertise in the matter of suicidal crisis, I am also an internationally regarded expert and clinical researcher and have published extensively on the issue — I have authored over 70 peer-reviewed publications and book chapters. I also won major research awards from the International Academy of Suicide Research.
I am intimately familiar with suicide assessment and intervention, as well as with the proper, widely accepted procedures associated with assessing and treating suicidal crises. Based solely on the description provided, asking a suicidal patient to ‘hold off’ until the next day and/or having the patient ‘promise not to hurt herself’ would not be seen as sufficient risk protection procedures in the case of intervening with an individual exhibiting intense suicidal ideation. This is especially true if there is evidence of preparation/planning/access to means for the attempt. In such cases, the provider has a legal and ethical responsibility to pursue more comprehensive intervention procedures, potentially including the pursuit of voluntary or involuntary hospitalization.