Staring out a tenth floor window of Clemens Hall into the dark September night, David considered his options and decided exactly what he was going to do: smash the window with a fire extinguisher, slit his wrists with scissors, and jump.
But after a long gaze at the sidewalk, David stepped away, walked back to the dorms, and never said a word about it. A month later, the night before he dropped out of school at UB, David told his friends about his near suicide, and when he went home he told a psychologist, but nobody else.
Maybe if his Resident Advisor were more than a closed door, David said, she would have noticed a change in his behavior. Maybe if his advisor had told him more about UB's counseling services, like where to find the office, he might have sought help.
"I'm sure I could've gone online and found something," David said. "But who wants to do that when you're in that state?"
Increasingly, universities are worrying about suicidal students like David who are nearly impossible to help because they keep their problems to themselves. Some schools have stepped up efforts to reach them with forced counseling and temporary expulsion, but that hasn't ended the debate over how to best treat suicidal students on campus.
At UB, it didn't matter to David what services the school offered.
"The way I was feeling, I didn't want take advantage of anything," he said. "I would sleep all the time, drink. The sleeping was ridiculous."
David is doing much better today, and next semester he's enrolling at a different school, but having slipped through the cracks at one university, he sees problems with the system many use to prevent suicide.
"You can always say it's up to the kid," David said. "But you don't want to do anything. You're so hopeless, you don't care."
According to Dennis Black, vice president for Student Affairs, UB doesn't have a comprehensive suicide prevention program that can be found on a Web site or in writing. Rather, it works on a case-by-case basis and over the years has informally adopted parts of other universities' practices.
"We kind of kicked into gear more assertive programming on our campus in 2002 when in the spring of that year we did have two student suicides," Black said.
Following that semester, UB revamped its awareness programs in the dorms and aimed to better train RAs. A guidebook was put out for faculty and staff on how to assist suicidal students, and UB re-established its relationship with Buffalo Crisis Services. Years ago UB had its own crisis hotline, but it was shut down when no one used it.
"We now have a protocol for students who either express tendencies or talk about suicide," Black said. "But it doesn't include any mandatory counseling, and it doesn't threaten to suspend you from the university."
Through suggested counseling, and sometimes family intervention, UB's approach is that "we continue to work with students who are fighting depression or anxiety," Black added. "As long as you're willing to work with us, we are willing to work with you until we've exhausted all that UB can do."
'An Unacceptable Option'
In a culture where schools find themselves sued by the families of suicidal students, other universities haven't shown the same patience as UB.
The University of Illinois at Urbana-Champaign was one of the first to establish mandatory counseling 20 years ago. According to Paul Joffe, the program's director, any students who threaten or attempt suicide are required to attend four counseling sessions. The program has a 95 percent compliance rate and none of the students who have gone through it have committed suicide.
"We felt that we needed to emphasize a community standard," Joffe said. "We don't think violence is right, whether it's directed at another person or towards ourselves. We've drawn that line here."
Based on the model at Illinois, and with guidelines from the a suicide prevention organization called the Jed Foundation, the University of Puget Sound also now uses mandatory counseling for those who make their problems public. According to Donn Marshall, director of Counseling, Health and Wellness at Puget Sound, suicide lawsuits against MIT and Ferrum College were factors in deciding to update and make official his school's practices.
By working closely with student organizations and RAs, Puget Sound has developed an on-campus atmosphere where suicide is an unacceptable option, Marshall said.
"That's really the emphasis for me," he said. "It's really from a place of, 'we care about you, and we want to help you learn more effective ways of coping so that you can be a success story.'"
On the subject of suspension, Marshall said because depression is a disability, "You can't throw someone out of school because they're depressed, but you can have behavior standards that you expect all students to adhere to."
Holes in the System
But no matter what a school adopts, no policy is perfect. The University of Illinois still had a handful of suicides last year, all by students the mandatory counseling never reached.
According to one study, every year there are about 1,100 suicides on campuses nationwide. In 20 years, the rate of 7.5 per 100,000 students hasn't really changed, so the basic questions remain. How do you best reach students who hardly hint they're suicidal and never seek help? Where do you draw the line between prying too much and not prying enough?
At Duke University, administrators are urging faculty and staff to take a more active role in suicide prevention. If Larry Moneta, vice president for Student Affairs at Duke, hears about a troubled student, "I'll ask an RA to do me a favor, swing by and see what's going on."
"I have to be very respectful of the right to privacy, and not be too intrusive," Moneta added, saying he doesn't ask for formal reports when he asks staff to intervene.
Like Columbia University recently did, Moneta has withdrawn students from school because they were suicidal. If anything else, he said, it forces them to take responsibility for their actions.
"It's one of the most complicated situations," Moneta said. "Obviously involuntary withdrawal is an extreme option." He added: "A lot of this is more art than science."
According to Dennis Black, UB is watching closely what other schools are doing and weighing the benefits of certain prevention trends. For instance, Black said counseling services here already use guidelines from the Jed Foundation.
"You can't do this by statistics," Black said. "You can't say because we didn't have a suicide this year or last year, we're doing a better job. We need to be concerned about the changes in Oregon (where a no-tolerance policy was enacted), and we need to be looking at some of these other programs to see how effective they are."
"I think that we're doing a great deal but we're also interested in what others are doing," he added.
At Puget Sound, Marshall highlighted three things that reduce suicide rates: less access to weapons, a cultural disapproval, and a mandate for treatment.
Ellen Christensen, director of Health Education and Human Services at UB, questioned mandatory counseling's effectiveness. Students should find someone they're comfortable with, she said, not someone they are forced to see.
In Christensen's mind, what schools need to do most is increase suicide awareness. "I think that's the biggest thing, and at UB how do you make people aware?" she said. "It's a really difficult thing."
Even more difficult for David was to be aware and feel paralyzed to speak out.
"I think I would've done anything," he said when asked about mandatory counseling. "I was dying to talk to anybody about something, but I couldn't because it was too hard to bring it up in the first place."
Aware and Ready
Although administrators nationwide debate how much the responsibility should fall to the school, the answer is obvious to David.
"It totally is (UB's job), because the university becomes your parent at that point," he said. "You're helpless. You can't do anything."
Christine Calmes, assistant director at UB's Psychological Services Center, agreed UB could do more when it comes to awareness. Right now, she said, suicide remains a largely taboo subject, but awareness events that get people talking would help create a better atmosphere for students to come out with their problems.
"It's sad that there's only so much we could do, especially when there are people falling through the cracks," she said.
Considering the pressures of school and the personal questions they face, college students are particularly vulnerable to falling through, Calmes added. According to Dennis Black, over the years there's been a "tremendous" increase in the number of UB students referred to counseling or seeking help.
Christensen, however, said college students aren't any more depressed or suicidal than they were decades ago, but today the proper diagnoses and medicines to handle troubled students make it seem otherwise.
Either way, colleges always have good reason to revisit the questions concerning suicide.
"Last year I asked our staff members in our counseling center to do an analysis of our readiness," Moneta said. "I don't want to wait until there's a suicide to look at out practices."
