The role of the academic advisor in preventing student suicide
Authored by: John Hipple
2010

Suicide is the second leading cause of death among college students. In 2007 the suicide rate was 7.5 per 100,000 students; this translates into more than 1,000 completed suicides each year (National Institute of Mental Health, 2008). It is estimated that for every completed suicide there are 200-400 unsuccessful attempts. The American College Health Association’s (2007) survey of college students found that 9.5% of students had seriously contemplated suicide. With numbers like this, it is not ‘if’ an academic advisor will be faced with a student who has contemplated the option of suicide, it is ‘when'.

What sets the stage for a student to think suicide is an option is not always as clear as we would like. However, there are some patterns which can assist the advisor in more quickly identifying who might see self destruction as an alternative. Twenge, et al (2009) report that all categories of mental illness are on the increase among college students with depression being called the ‘royal road ‘ to suicide. Furr, et al (2001) found that 53% of surveyed students reported they experience bouts of depression since entering college.

Depression
With depression a major factor in the development of suicidal options, the more advisors can be aware of the primary symptoms of depression, the more quickly appropriate actions can be implemented. A complicating factor is that the normal sadness which results from loss and transitions often looks much like depression. The primary difference is that the pain of depression is deeper, lasts longer, and impacts the individual’s world in a more intense fashion. While counseling is certainly appropriate for those suffering from sadness, it is a must for those clinically depressed, especially since depression is an accurate predictor of suicidal thoughts and plans.

The primary symptoms of sadness and depression include increasing emotionality. Women tend to exhibit their sadness more openly and clearly while men often show more irritation and frustration. The depressed find intellectual pursuits a challenge as they have increased difficulty meeting the cognitive demands of an academic program and thus a lowering of motivation. The depressed student has problems taking in information and putting it out either verbally or in written form. Physically there is a sense of increased fatigue, changes in eating and sleeping patterns, and a reduction of sexual interest. Socially, depressed students have a tendency to withdraw from others. For the depressed who have difficulty intellectually, emotionally, and physically, it is doubly difficult to be around people. The few depressed who reach out ‘too’ much to others for assistance may find that friends and family push away because they are either overwhelmed by the student’s situation or do not know how to be of help.

These symptoms tend to build up over time with an ebb and flow to their intensity. The depressed student often finds this confusing and not only difficult to cope with but quite difficult to explain to others. It can be difficult for the student to identify what exactly is the loss or change that has set the stage for these uncomfortable feelings.

Students who experience the sadness or depression to a degree that their lives are in an uproar should be referred for counseling. For those students experiencing depression, counselors may suggest a visit to a physician for a medication evaluation.

Stress  

Some students consider suicide because of the build-up of psychological stress. There are times of predictable stress for students such as the start of school, mid-terms, or final exams. Some are overwhelmed by unpredictable stress such as accidents, the death of a loved one, sickness of self or others, or any other life situation which is troublesome. Probably the most common stress for college students is what can be called “exhaustion stress” when the student has experienced a number of life difficulties in a rather short period of time. Typically this student deals with each individual situation in a constructive manner, but gradually the reserves of emotional energy, cognitive strength, physical stamina, and social support become depleted. When the last event takes place, the student collapses in all areas because few internal or social supports remain to deal with the last situation.  Ironically the “final straw” can seem quite minor to the student and others. Consequently the student often feels doubly inadequate and confused.

The open and accepting advisor can be of great assistance to the stress victim by being willing to help identify the stressors and offering an explanation as to why the last situation caused a serious break down of coping skills. As the total picture develops, the student will tend to understand the situation more clearly and not feel so emotionally discouraged. Consequently the move into a suicidal position can be averted.

Characteristics of the suicidal student

Students contemplating suicide share some common personal characteristics including feeling: 

• Helpless.This is probably the most common characteristic. The student has been experiencing deep pain and has been struggling to reduce that pain for some time, but to no avail. He does not know what else to do. If this is true, then the advisor must be willing to take an active, directive, supportive, and helpful stance. 

• Hopeless.Often the pain has been going on for so long with no relief, that the student is ready to give up on everything and everyone. From the student’s perspective there is little reason to live. Reasons to continue to live often require input from an outside resource.  As an intervention, the advisor can help rebuild a student’s sense of hope for life. 

• Confused and having difficulty articulating what is happening. The student knows that something is amiss but is not able to clearly describe the internal processes taking place. Friends, family, and even instructors may find this confusion leads to them minimizing the seriousness of the situation. The advisor can help the student talk through the confusion. 

• Perfectionistic. Acute perfectionism can set the stage for the student to see suicide as a viable resolution to pain experienced when his actions, or lack of action, fail to meet high standards. Since little or no action is taking place, the emotional pain continues to grow. Consequently the advisor has an opportunity to help the student problem solve and see alternative or more realistic solutions. 

• Isolated. Feeling helpless, hopeless, confused, and idealistic, the student contemplating suicide often has difficulty being with herself let alone seeing how others might want to be with her. It is common for the suicidal student to distance herself from others thus making it doubly difficult for others to be supportive of her. The advisor can assist the student to reach out to others in a more realistic fashion and consequently re-create a helpful support system. 

• Ambivalence.This is a critical characteristic of all individuals who look at suicide as an option. In simple terms self inflicted death may be something thought about, planned for, and even attempted. However there is also a life sustaining element in operation for the suicidal; if someone is 100% suicidal he would already be dead. It is helpful during conversations to assist the student to talk about both sides of his ambivalence. The suicidal student needs the advisor to not minimize or deny the ‘death’ side; instead he needs assistance in talking through reasons to stay alive. One could call this a pro/con discussion of the entire situation. From a practical perspective, conversations are never ended while the student is deeply connected with the ‘death’ option. 

Risk assessment
Advisors are not expected to function as therapists or counselors, however as a helping professional  interacting with a student, there are some minimal standards for establishing how immediate is the risk for suicide (Paladino & Bario Minton, 2008).

Be willing to directly ask if the student is thinking about suicide.  “I am wondering if you are in so much pain that you are thinking about suicide?” Don’t be afraid to be upfront with asking this question, it will not put the idea in a student’s head. If the student is thinking about suicide she may already be planning it. This question will not cause the ‘non-suicidal’ student to think that suicide is a solution to her problems. If the answer is “No”, the response can be “Good I am glad” and the conversation can then be directed back at some of the stressors which the student has identified. If the answer is “Yes”, then the counseling center should be called, the student walked to a counselor, or the campus suicide intervention plan should be triggered.  (All academic advisors should be aware of their campus suicide prevention plan.)

Some students may make vague statements such as “My life is not worth living.”Or “I’m not sure there is any point anymore.”  Here too it is important to ask “Are you thinking of killing yourself?” It is not unusual for a student to say “Things are so difficult that I have thought about it.” If the student is thinking that suicide is an option in the current situation then the actions prescribed by the campus suicide prevention plan should be implemented or a counselor called.

It is not unusual for students who see suicide as a viable option to minimize the seriousness of their thoughts or to reject counseling. The advisor must resist the temptation to go along with this hesitancy. It is critical that the advisor encourage the student to take positive steps to lessen the psychological pain at the base of any suicidal thoughts. For students resistant to taking action, the advisor must be willing to involve others. The student who is seriously at risk for suicide is not protected by confidentiality guidelines, so privacy should not be a factor in the advisor seeking consultation or making a counseling referral. Other viable actions for students who answer “yes” are to bring in the Dean of Students, a member of the institution’s Behavioral Assessment Team, or a campus security officer to mandate constructive action to protect the suicidal student from himself.

Successful referrals
As the conversation evolves the immediate risk of suicide will become clear. If there is a risk then the advisor must successfully refer the student to someone with psychological and/or counseling training. The more personalized the referral, the more apt the student will follow up; when students meet counselors face-to-face then they are more apt to connect and follow through to work on the issues that caused the suicidal thoughts.

Counseling interventions
It is important to again highlight the fact that the typical academic advisor is not in a position to assume the role of counselor. However, it can be helpful when the advisor has a basic understanding of counseling interventions. The first goal of any intervention is to keep the student safe.

When counselors are brought in after a student has answered “yes” to the question “I am wondering if you are so much in pain that you are thinking about suicide?” the counselor most often will ask “I am wondering if you have plans for your suicidal thinking?” In many cases the answer to this question will be “No”.  In these cases the response is usually “Good, I’m glad for that” but should be followed up with “I hope that if you ever do start making plans that you will stop and come to see me or someone else on campus.”  In general, thinking about suicide as a problem solving option is quite common.  Most who think of the option don’t have an action plan in place. Once it is established that a plan is not in place then the counselor can move the conversation to examining issues where the advisor can be of greater support.

However, if the answer to “Do you have plans for suicide” is “Yes” then there is yet another line of questioning. When the answer is yes, as calmly as possible the counselor will state something like“  I am interested in hearing the details of your plan” to better understand the risk.  Again, it is important to understand that talking about it will NOT plant ideas in the student’s head. Typically the student is grateful that someone is not afraid to know the details of their suicidal thoughts:

• Weapon (means) and its dangerousness
• Availability of the weapon
• When the act will take place.

This discussion will help the counselor understand the chance for rescue. If the student has a gun and plans to go off somewhere and use it, then the risk is high. If the student is going to take a handful of pills at home where others are present, the immediate risk is somewhat reduced. As this conversation proceeds the counselor will determine the intentionality of the student and will be able to better know how serious and how dangerous the threat to the student. The counselor will also find out if the student has previously attempted suicide and what were the outcomes any such incident.  Additionally, the counselor will determine the level of alcohol or other chemical use as drug and alcohol use can increase impulsiveness.

It is important to again highlight that most students will be appreciative of the counselor’s willingness to ask these questions. Showing interest and remaining calm can increase the student’s sense of hope and reduce his feelings of isolation. At this point the campus counselor may reach out to trained professionals beyond the campus community. This might mean in-patient hospitalization. Or it can mean finding friends or family to be with the student to insure personal safety.  In some instances this requires that any weapon be removed from the student’s access.  For the student with intense depression and anxiety symptoms, medication may be prescribed as a part of any holistic treatment to reduce emotional pain.

As the counseling progresses the student will learn coping skills, new ways to ask for help, and how to better cope with pain. As the student gains an increased sense of being heard, supported, and belonging, internal feelings of hope will result and suicide becomes less likely. Counseling often focuses on increased understanding and personal insight. Changes in behavior reduce suicidal thinking and behavior.

Conclusion

Suicide on college campuses is a serious issue. Academic advisors by their very nature seek to establish warm, open, and supportive relationships with their advisees. As such advisors are often the first line of defense in identifying a student at risk for suicide and securing the help needed so that the student can confront and overcome these self-destructive thoughts. There is no expectation that counseling should be provided by advisors unlicensed in mental health counseling. However, as advisors become more aware of the underlying signs, symptoms and characteristics of suicidal students, it will be easier for the appropriate steps to be taken.

Authored by: John Hipple

Counseling & Testing Center

University of North Texas

References

American College Health Association-National College Health Assessment (2007). Data  highlights.  Retrieved from: http://www.acha-ncha.org/data_highlights.html.

Furr, S., Westefeld, J., McConnell, G., &  Jenkins-Marshall, J.  (2001)  Suicide and depression among college students: a decade later. Professional Psychology:  Research and Practice, 32, 97-100.

National Institute of Mental Health (2008) Suicide in the US: Statistics and Prevention.

www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml.

Paladino, D & Barrio Minton, C.A., (2008). Comprehensive college student suicide assessment: application of the BASIC ID. Journal of American College Health, 56, 643-650.  

Twenge, J.M., Gentile, B., DeWall, C.N., Ma, D., Lancefield, K., & Schurtz., D. R. (2009) Birth cohort increases  in psychopathology among young Americans, 1938-2007: a cross-temporal meta –analysis of the MMPI. Clinical Psychology Review, 30, 145-154.

Cite this using APA style as:

Hipple, J. (2010). The role of the academic advisor in preventing student suicide. NACADA Clearinghouse of Academic Advising Resources. Retrieved from http://www.nacada.ksu.edu/tabid/3318/articleType/ArticleView/articleId/92/article.aspx