Student Self-Harm Response Protocol

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This document details the procedures and processes for Earlham College to work in conjunction with currently enrolled students (undergraduate and MAT) who are exhibiting a level of harmful behavior (including, but not limited to, ideation, threats, gestures, and attempt/s). The primary goal for this Protocol is to create a process for the College to increase the mental health awareness of the students, and to provide positive guidance to both the faculty and staff that may be assisting with the student(s) in crisis. This protocol:

  • Establishes a Self-Harm Assessment Team (SHA Team) to evaluate the level and risk connected with the behavior. The SHA Team will include members from the Counseling Services, Health Services, Student Life, the Office of Religious Life departments and others as determined appropriate.
  • Provides definitions to assist the front-line campus staff/faculty to describe behavior they may encounter.
  • Creates an intervention action process that may be utilized when appropriate and recommended by the Earlham College SHA Team.
  • Defines specific guidelines for assessing the implementation of the protocol.
  • Describes a Family Notification Policy that establishes a college process for sharing with parents/guardians and other family members when such involvement might be of value in coordinating with the student, subject to applicable privacy laws.

As noted, the primary purpose of this protocol is to establish the development of the SHA Team to effectively review each student’s report of their suicidal and/or self-injurious behavior and to make an assessment of the alleged risk or threat of harm to self or others, to the extent known and/or feasible. The members of the SHA Team may require a student to cooperate in a minimum of three sessions with the Earlham College Counseling Services, Health Services, or other off-campus mental health professionals. A student may be counseled to consider withdrawal from the College if the student is not agreeable with the recommendation/s of the team.

The members of the SHA Team will complete initial training to the administrative faculty as necessary. The SHA Team members will be available for consultation as the protocol is introduced as well as to provide ongoing support with the process.

Philosophy

Earlham College strives to foster an environment that invites students to maintain a standard of responsibility and positive self-care (the ability to respond adequately to one’s emotional, mental, physical, and educational needs). Students who are distressed may engage in concerning behaviors that impact themself and the welfare of the college community.

The existence of demonstrated suicidal intent, self-harm behavior can be a predictor of eventual suicide. While a prediction cannot be made with any degree of certainty that a distressed student will commit suicide, there are behaviors that demonstrate an increasing probability of that risk. The behaviors may require further/ongoing assessment by appropriate licensed mental health or medical professionals to ensure the safety of the student, community, and individuals involved. The purpose of the assessment is to assist the student by connecting with the appropriate services to afford the student the opportunity to improve his or her welfare and the welfare of the community. Given that a suicidal student might not seek services voluntarily, the student may need to be mandated to do so administratively through Student Life or Counseling Services. Therefore, students who exhibit these behaviors may be required to participate in mandatory psychological evaluation with necessary follow-up services. If an Earlham College student is unable to maintain a standard of responsibility and self-care, various resources on campus are available to assist the student to return to adaptive levels of day-to-day functioning. Students who become suicidal or harm themselves may be compromised in their ability to ensure their own self-care. Therefore, college faculty/staff on the Earlham College campus can make a report to the SHA Team using an online Self-Harm Behavior Report Form. Federal and state laws and professional ethical requirements of confidentiality limit reports from health and mental health professionals.

Procedure

A Suicidal Behavior Report Form should be completed if during the past or current semester a student has engaged in any of the following at-risk behaviors:

  • Suicidal ideation: Having thoughts of suicide or of taking actions to end one’s own life. Suicidal ideation can be vague or specific and infrequent or persistent.
  • Expression of suicidal intent: Public announcement of intent to die (written or verbal), which may include acts such as giving away personal possessions. Writing examples may include passages from social media sites, classroom assignments, online journals, etc.
  • Suicidal threat: Verbalizing ideation, intent and means to follow through on a suicide attempt. This includes preparation of means (purchasing of a firearm, weapon, stockpiling pills, etc.) or practicing how one would carry out their intent (putting bullets in the gun; holding a knife over one’s wrist, etc.)
  • Suicidal attempt: The act or gesture in which a person engages in life-threatening behavior(s) with the intent of jeopardizing or ending his/her own life.

The completed report is submitted to the SHA Team for the purpose of determining if the suicidal behavior warrants further assessment and what action should be taken as soon as possible (the target response period is within 24 hours). The report form is sent to the Dean of Students (or designee) for review by the SHA Team. A member of the SHA Team may contact the person making the report to collect further information also within the target 24 hour period. If the student is indicating imminent harm or high risk, immediate actions should be taken such as calling 911, EC Public Safety or the closest emergency room.

After a form is received, the SHA Team will review the form to determine if the behavior passes a threshold that warrants mandatory assessment (see SHA Team Guidelines below). The determination of the SHA Team will be communicated to the Vice President/Dean of Students (or designee). If the student’s behavior does not meet the threshold of suicidal behavior, a letter will be sent to the student the same day clarifying the standard of self-care protocol and
providing information about support services. The student may also be referred directly to the Counseling Services or other appropriate resources. If, upon review of the report/form, it is determined that the student’s behavior did cross the threshold of harmful behavior, the student will be contacted, informed of the standard of self-care protocol, and mandated to three sessions of professional assessment of suicidal behavior. A follow-up letter will be sent immediately.
Each self-harm behavior report form filled out (regarding subsequent incidents) on behalf of a student will result in a requirement for additional mandated three sessions of professional assessment. More than three forms submitted for one student during an academic year will result in further review by the team and possible additional actions (mental health referral, transition to alternate living situation, etc).

The student will need to have, or schedule, a session (can be involuntary) with a licensed mental health professional for an assessment within one business workday of receiving notification of behavior that crosses the threshold of harmful behavior. The student will be asked to complete a release of information to allow the counselor to disclose to the SHA Team the student’s attendance at each appointment attended. It is expected that the remaining three sessions will occur approximately weekly following the initial session (consideration of the time of year is put into place).

If the student does not comply or is not able to maintain the recommended standard of self-care, the Dean of Students will follow up with the student accordingly. If the student does not follow through with this guideline, that student will be referred to the Dean of Students for a discussion regarding non-compliance with the SHA Protocol. At this time, an off-campus referral for an evaluation may take place can involve a mandatory medical leave of absence.

If the student withdraws from the college or completes the semester prior to finishing the mandated sessions, the student may be asked to finalize an assessment before enrolling in the following semester.

The mandatory assessment sessions may involve an assessment of the student’s current suicidal ideation, intent, plan, and access to means, a reconstruction of the circumstances, thoughts, and feelings that surrounded and precipitated the incident, a history of the student’s previous suicidal behavior, thoughts, and feelings, and a discussion of the College’s standard of self-care and the consequences for failing to adhere to this standard. In addition, the student will be expected to complete standard psychological assessment measures.

While the SHA Team is completing the report process and the suicidal behavior increases, warranting mandatory assessment, the SHA Team uses the perspective of a “reasonable” observer, which asks the question of whether a reasonable observer would interpret the student’s statements or behavior as suicidal. The threshold of suicide behavior may be met if at any time in the last three months a student has exhibited significant suicidal ideation that is persistent, has expressed suicidal intent or threat, or has made or engaged in actions with the intent to end their life (suicide attempt.) Guidelines utilized by the SHA Team include:

The above are intended as guidelines only. In all cases, the SHA Team will make an individualized assessment based on all of the information reported. If a student meets the criteria for imminent self-harm or suicidal behavior, the threshold is automatically crossed, upon being informed, immediate actions are taken such as calling 911 or contacting the Earlham College Department of Public Safety or the Reid Health (or local) emergency room.

  • The duration and magnitude of the action and its potential effectiveness are immaterial in deciding whether the threshold has been crossed.
  • Significant ideation with persistent thoughts, images, or intent with or without any conscious plan to engage in self-harm or suicidal behavior may cross the threshold.
  • Statements or actions that occur in the context of being intoxicated or using drugs may cross the threshold since a high percentage of students who commit suicide do so in the context of being intoxicated or using drugs.
  • Actions that prepare for eventual suicide may cross the threshold.
  • Self-destructive actions, such as cutting and self-mutilation, in the absence of intent, may cross the threshold.
  • Joking statements may require more information and the establishment of a boundary to determine whether the threshold has been crossed. A pattern of joking comments in the face of concern and a request to stop making them may cross the threshold.
  • The threshold of suicidal behavior may not be met if the student expresses suicidal ideation that is vague, passive or passing.

Behaviors (refer above for definitions) that may increase may result in similar requirements of three sessions of mandated assessment to Counseling Services. The student will be informed about the appeal process and can appeal within one week to the Student Life Office. The student can challenge and/or clarify the information included in the report given but may not appeal the decision that the student’s behavior crossed the threshold of suicidal behavior mandating a mental health assessment.

Family notification policy

Earlham College will provide services for students who are experiencing a mental health crisis according to the highest professional mental health practices and will also respect student privacy rights as defined by the Family Educational Rights and Privacy Act and College policy. In certain cases, it may be required to reach out to a student’s parents or other family member to provide support to assist the student. The Family Educational Rights and Privacy Act (FERPA 99.36) will be used.

It may be difficult to balance a student’s right to privacy with the value of family support and involvement in crisis situations. Ultimately, professional judgments must be made as to when it is appropriate for the College to contact family members on behalf of a student. The College will give family notification responsibility to a team of staff who evaluate the situation based on information that is available through incident reports, police reports, mental health evaluations and other information as may be available concerning the student. The team will be used when possible and will include but will but not be limited to the following persons or their designee.

  • Director of Counseling Services
  • Dean of Students (or designee)
  • Legal Counsel (Provided by the College)

We abide by the federal and Indiana state laws along with professional ethical requirements of privacy and confidentiality, family notification may exist under the specific circumstances:

  • Student has engaged in self-inflicted life-threatening behavior.
  • Student is a danger to themself or others and is unresponsive to professional medical or mental health guidance.
  • Student has completed self-injury and needs immediate off-campus medical attention.

Earlham College will make an effort to contact family members in these circumstances, family members will not be contacted in all mental health situations. The college may or may not contact family members in the event of a mental heath crisis if the faculty determines that family support may be positive in assisting the student. For example, family members of an international student may not be able to assist while other support systems may be more useful. Also, a student’s family may not be contacted if there is information indicating that the family will not be supportive of the student.