Colleges and suicide threats: when to call home

The email that arrived at Virginia Tech's health center in November 2007 was detailed and unmistakably ominous. It concerned a Tech senior named Daniel Kim and came from an acquaintance at another college. "Daniel has been acting very suicidal recently, purchasing a $200 pistol, and claiming he'll go through with it," the email read, adding details of a reported previous suicide attempt with pills. "This is not a joke." By the time Virginia Tech told Daniel's father, William Kim, about that email, it was too late. A few weeks after it was sent to the school, he spoke with his son for the last time, Daniel indicating all was well and after final exams he'd be home for the holidays. A few days after that, parked in his car outside a Target store near campus, Daniel fatally shot himself in the head. "If I'd known, I could have taken him to doctors, get him on medication, make him normal again," William Kim, who owns a Washington, D.C., convenience store, said in a recent telephone interview, grief still echoing in his voice four years after the fact. Virginia Tech's actions were all the more confounding coming just months after the murder-suicide rampage on the same campus by another student, Seung Hui Cho, which had supposedly prompted campuses nationwide to rethink their previous emphasis on confidentiality in treating troubled students. "Who is going to take better care of him than his parents?" Kim said. "I never had the chance to do anything for him. That's a terrible feeling." In an agreement finalized by a judge last month in a multimillion-dollar lawsuit brought by the family, the Kims settled with Virginia Tech for $250,000, plus an endowed scholarship in Daniel's name. But William Kim also insisted that the agreement include language requiring Virginia Tech to notify parents of a potentially suicidal student unless it documents a reason not to do so. The university, which admits no fault, maintains the language reflects policies already in place there under a 2008 state law, and wouldn't have made a difference for Daniel Kim anyway. It continues to insist that, after sending local police to check on the student, and despite the detailed email, it had no reason to believe he was actively suicidal and thus didn't need to notify his family. But the family's attorney, Gary Mims, insists the settlement goes further than the state law, which applies only to students treated by university mental health services. Now, he says, Virginia Tech must at least consider notifying parents if it receives an indication from any source a student may be suicidal. Several experts described it as among the strongest such policies in the country. The issue of when colleges should notify parents their adult children may be suicidal remains fraught with legal, medical and ethical dilemmas. College policies, state laws and professional codes of conduct vary widely — and occasionally conflict. Some mental health professionals call the Virginia Tech settlement the latest step in a trend they welcome: Threats to safety increasingly take precedence over preserving confidentiality. They emphasize that in many cases, involving parents is not only right, but helpful. "There's some good evidence if someone is really sick, that involving family in their treatment planning, the medication, helping them stay on track, are really good things to do," said Greg Eells, director of counseling and psychological services at Cornell University in New York, which has changed several policies to make notifying parents more common. "I think the (Virginia Tech settlement) is kind of affirming that." But many remain wary of top-down pressure on counselors to notify parents as the default option, even if such policies are well-intentioned and allow exceptions. Many students have just passing thoughts of suicide. Also, relationships with parents may be part of the problem. Involving them too readily might discourage some people from getting help, or complicate treatment once they do. "The less flexibility we have, it actually compromises care," said Mary-Jeanne Raleigh, director of counseling services at St. Mary's College in Maryland and president of ACCA, the American College Counseling Association. Overly rigid policies mean, she said, "I can't review what is best for the individual standing in front of me because the law is saying you have to x, y and z." Suicide is the second leading cause of death for college students, behind automobile accidents. A 2010 survey of counseling center directors found at least 133 college students had taken their lives in the previous year. The better indicator is probably the rate, estimated at about 6 to 7.5 per 100,000 — though that's only about half the suicide rate for similarly aged people not in college. But while the research highlights the danger, it also sheds light on why these are tough calls for colleges. Warning signs aren't always as black and white as they were at Virginia Tech. A milder form of suicidal ideation — fleeting hopelessness or thoughts about death —is common among college-age students. A 2009 survey of 26,000 students at 70 colleges found that roughly half reported having had at least occasional suicidal thoughts. But more than half of those said such thoughts lasted a day or less. Roughly 6 percent of undergraduates reported they had "seriously considered attempting suicide" in the last 12 months. Colleges must determine who's most at risk — typically those who have made detailed plans and acquired means such as a weapon or pills. "Someone who's seeking help but says, 'I have to admit I have these thoughts five or six times a day and they're kind of scary' — that's someone I wouldn't necessarily feel compelled to call the parents right away," Raleigh said. "That's very different from the person I get a call from at 3 o'clock on a Saturday morning who's been drinking and has immediate plans to kill themselves." The 2010 survey of counseling directors found that when a client was considered a "suicidal risk" but didn't meet the state-law criteria for involuntary hospitalization, 41 percent wouldn't notify anyone else without a signed release from the student. Only 13 percent said they would notify family; 22 percent said they would notify a superior, and 19 percent said it would depend on the situation. Why the hesitation to involve family? The data also show why colleges worry so much about any action that might discourage troubled students from seeking help: 80 percent of students who commit suicide, like Kim, never participated in campus counseling services. "I'm in favor of notifying parents," said Carolyn Wolf, a mental health lawyer who advises college officials. "These are kids who are 18, 19, 20 years old, they're legally adults, but I don't think they're developmentally adults at that point. Parents are much more involved in kids' lives these days for a longer period of time." Still, she said, "you need to give some amount of flexibility to those people who are in the trenches." Wolf advises parents to remember that FERPA, the federal education privacy law, has clear exceptions for risks to health and safety, as do state laws. HIPPA, the federal medical privacy law, generally doesn't apply to colleges. And while counselors and psychiatrists may be unable to discuss a student they are treating, those rules don't apply to anyone else on campus; faculty and administrators can call home about behavioral issues. And, Wolf points out, nothing forbids counselors from listening. Parents "can call a counseling center and say, 'I think this meets one of the (confidentiality) exceptions, but even if you can't tell me things, you need to listen to me give you history, give you information,'" Wolf said. William Kim's lawsuit against Virginia Tech contends the school broke its own protocol, which called for any student who had made even a gesture about suicide to see a psychologist on call immediately. Instead, officials discussed the email the morning they received it, and dispatched a local police officer to Kim's off-campus residence. The officer reported Kim "appeared to be OK" and that Kim said he didn't know the student who had sent the email. That student appeared to know Kim through online gaming. The university also checked to see if Kim had purchased a gun. Apparently he had not, but did so a few weeks later. Confidentiality laws would not have prevented Virginia Tech from contacting Kim's parents because he was not a patient of the university counseling center. But university officials decided not to reach out. Having received no other unsolicited indications from family, acquaintances or teachers that Kim might be suicidal, they concluded he was not a danger. Ed Spencer, Virginia Tech's vice president for student affairs, acknowledged that the university has wide latitude to contact family if a student is suicidal, and said it would do so if it made that determination. But, he said in a telephone interview, Daniel Kim "was never found to be suicidal by anyone here at Virginia Tech or by the Blacksburg police." Regardless of the detailed plans reported in the email, altogether "there was nothing that added up that he was at all suicidal," Spencer said. He added experts the university consulted backed up that view and "were surprised we went the extra mile" of checking on the gun. But Mark Mills, a Columbia University psychiatrist retained by Kim's attorneys, found the email alone represented clear evidence of a "psychiatric emergency" and that it was "irresponsible and reckless" that Virginia Tech failed to take further action to see if Daniel needed help. When William Kim asked university officials why they hadn't told him about the email, he says they told him it was "unnecessary." Kim responded: "It was unnecessary? My son's life was in danger, and you didn't think it was necessary?" "They didn't call his teachers, other students, they didn't call me," said Kim, who emphasized he was not angry at Virginia Tech as a whole. "Nothing was done whatsoever to save him." Daniel Kim was a happy kid, said his father, who only later learned his son had agonized about his perceived resemblance to Cho and experienced anti-Korean slurs after the shootings on campus the April before he took his own life. Only later did William Kim learn his son had secluded himself for two weeks in his dorm — the same building where Cho killed his first two victims. "When somebody's life is in danger, all the privacy, that should go out the window," he said. "No matter how bad your relationship with your parents, when something like that happens you want to know." He added: "He was suffering at that school. We had no idea.""