Paul Joffe, a psychologist at the University of Illinois at Urbana-Champaign, was asked in 1983 to examine the files of 19 students who had committed suicide in the previous eight years. He found that many of them had talked about or made attempts to kill themselves before succeeding. So Joffe began a program at the university’s counseling center that sought to persuade students to undergo counseling if they showed signs of being suicidal.
The program wasn’t successful at first. Only about 5 percent of the students could be talked into seeing a counselor. So, with the support of U. of I. administrators, Joffe made the counseling mandatory. Since 1984, students who threaten or attempt suicide are required to attend four 50-minute counseling appointments. If they don’t comply, they are not allowed to remain enrolled at the university.
That program has been highly successful. Of the 1,800 students who have been through the program, none has committed suicide while enrolled at the university; only one student left school because she refused to go through the counseling program. (She eventually re-enrolled after seeing a counselor off campus.)
Joffe, who continues to head the university’s suicide prevention program, recently discussed suicide prevention. Following is an edited transcript of the conversation.
Q. A recent American College Health Association study reported that 10.1 percent of college students seriously considered suicide over the 2003-04 school yearand 1.3 percent reported attempting suicide over the last school year. Are incidents of suicide attempts on the rise on college campuses and at the University of Illinois?
A. I’m not sure I have a clear impression [of what’s happening around the country], but we saw approximately 170 reported incidents of suicide attempts last year and 140 reported incidents the previous year.
Q. How has suicide typically been viewed?
A. It is typically seen as a cry for help, yet there’s no research showing an association with help-seeking behavior. In fact, research shows a resistance to seeking help. And there’s no evidence that anything we do lowers the rate of suicide. It seems appropriate to show concern [for the suicidal person], but there’s nothing that shows it lowers the rate of suicides. There’s no evidence that suicide hot lines or hospitalization or college mental-health resources lower the risk. These things are pretty much done just on faith.
Q. Was it difficult to persuade the university to try this unusual approach to suicide prevention?
A. There was some controversy within the mental-health community on campus, but we had the support of administrators. We showed them data that the majority of students who had committed suicide were known to be suicidal, but they weren’t getting help. Of the 19 who had committed suicide over an eight-year period, only one had any record with a licensed social worker.
Q. You have a different approach to treating people who are suicidal. What is that approach?
A. We approach suicide from a counterintuitive direction–specifically, that suicide represents an act of self-directed violence. When we work with people who are violent toward other people, we don’t assume a helplessness. We expect these individuals to make healthy choices and refrain from violence in the future. We apply this same set of expectations toward students who are engaged in self-directed violence. The university … says, “We care about you, we support you, but suicide threats and attempts are unacceptable on our campus.”
Q. How difficult is it to get students to comply?
A. Very difficult. It can take about 20 phone calls and letters to get them to come in four times. For a good number of them, there’s a power struggle about whether they feel they need to [see a counselor] and whether the university has a right to intervene.
Q. What happens during the four mandated sessions?
A. We call it an assessment. We assess what happened on the night in question, what led up to it, what they were thinking and feeling, then look for other attempts and then assess their current suicidal intentions. There’s usually a larger problem that surrounds their self-injury. When they’re done with the assessment part, we ask if they’d like to look at this other issue together and they’re invited to engage in therapy around this other issue. Roughly 15 to 20 percent [continue in therapy].
Q. Do you involve the student’s parents in the program?
A. We usually don’t if they are 18 or older. We will, though, if they aren’t coming in [for the sessions] or they’re still making suicide attempts. Then we might bring them in to get the student’s attention.
Q. How successful has the program been?
A. The suicide rate is now less than half of what it was before the program [about one per year as opposed to two per year before the program]. We still have suicides, but they’ve all been out of the blue, students who weren’t in the program and whom we had no prior knowledge of. Every student in the program has been able to move on and find other options.
Q. Did you expect the program to be this successful?
A. When we started the program, we felt we had to do something and this seemed like the right thing to do. I don’t think we expected it to lower the rate this much.
Q. Why do you think the program works so well?
A. There are two elements. One is the contact with a therapist. The other is that there is a community that is taking this seriously and is intervening and challenging this student. It’s establishing a standard of self-welfare and making a statement about [not accepting] violence to yourself.
Q. Why are some schools uncomfortable with your program?
A. Some would say it’s inappropriate [to threaten a suicidal student with expulsion], but when you think about it, they’ve just tried to take their own life and we’re requiring four hours of their time. That doesn’t seem unreasonable.
Q. Only a couple of other universities around the country so far have copied your program [the University of Puget Sound in Tacoma, Wash., and the University of Washington in Seattle]. Besides feeling it might be “inappropriate,” why aren’t more schools doing this?
A. The biggest impediment is that it’s a tremendous amount of work. The distress model is to leave it up to the student to do the work, although there’s no evidence they’ll do it. Our program puts the stress on the community [to report the suicide attempt and then get the student into assessment sessions]. It requires a substantial administrative structure.
Q. How many people work in this program?
A. The suicide prevention team consists of three psychologists from the Counseling Center and McKinley Health Center’s Mental Health Department and an administrative support person. I’m given three hours a week to conduct the program, and the other two psychologists are given one to two hours a week. In addition, we have a reporting network of more than 1,000 staff members on campus who will submit a report when they are aware that a threat or attempt has occurred.
