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Less than two months after a landmark decision by the California Supreme Court that universities have a duty to protect students from foreseeable violence, the Massachusetts Supreme Judicial Court issued its decision that “a special relationship and a corresponding duty to take reasonable measures to prevent suicide may be created between a university and its student.”

This duty to protect a student from self-harm is triggered when a university employee:

  • Has actual knowledge of a student’s stated suicide plans or intentions, citing the Columbia-Suicide Severity Rating Scale (C-SSRS), or
  • Is aware that a student attempted suicide while enrolled or close in time to their enrollment at the university

However, the Court did not find a special relationship in the case before it because:

Han Duy Nguyen was a 25-year-old graduate student at the Massachusetts Institute of Technology’s (MIT) living off campus, not in a campus dormitory under daily observation

  • Nguyen never communicated by words or actions to any MIT employee that he had
    stated plans or intentions to commit suicide, and any prior suicide attempts occurred well over a year before he attended MIT
  • Nguyen repeatedly made clear that he wanted to keep his mental health issues separate from his academic performance problems and that he was seeking professional help from psychiatrists and psychologists outside the MIT Mental Health system

In reaching these conclusions, the Court considered the complex relationship that universities have with their students who are young adults. Nguyen was a 25-year-old graduate student  — an adult “in all respects under the law.” Federal laws require the university to be “respectful of student autonomy and privacy,” but the Court pointed out that that duty “may conflict with their immaturity and need for protection.”

Given the difficulty of balancing these conflicting obligations, the Court limited the duty of university officials — “nonclinicians” without medical training — to prevent a student’s suicide by detailing these steps that must be taken when they have actual knowledge of suicidal plans or intentions, or are aware that a student previously attempted suicide:

  • Initiating a suicide prevention protocol if the university has developed such a protocol
  • Contacting the appropriate officials at the university to assist the student in obtaining clinical care from medical professionals or, if the student refuses such care, to notify the student’s emergency contact
  • Contacting police, fire, or emergency medical personnel in emergency situations

University employees who are medical professionals are required to follow the standards of care established by their profession in providing clinical care to students.

While the Court acknowledged that it was placing a substantial burden on the university, the Court pointed out that the tuition a university received from its students is also substantial and cited these statistics to put the need for a limited duty to protect in context:

  • The Centers for Disease Control and Prevention (CDC) found that suicide is
    the second leading cause of death among 25- to 34-year-olds and the third leading cause of death among 15- to 24-year-olds
  • A 2017 American College Health Association survey of over 63,000 students at 92 colleges and universities found that 10.3 percent of students reported that they had “seriously considered” suicide and 1.5 percent of students had attempted suicide in the previous year

Therefore, similar to the reasoning of the California Supreme Court, the Massachusetts Supreme Judicial Court concluded that the “Moral blameworthiness on the part of a university in failing to act to intervene to save a young person’s life, when it was within the university’s knowledge and power to do so, is understood and accepted by our society.”

This decision should prompt colleges and universities to review their resources, policies, and procedures that address mental health issues for this high-risk population. The American Foundation for Suicide Prevention (AFSP) points out that many students suffer in silence, citing research that found less than 20% of students who died by suicide sought help at their school’s counseling center. Therefore, the AFSP recommends that schools adopt a comprehensive strategy to combat mental health conditions that negatively impact college students’ academic and personal functioning, including educating the campus community on:

  • Reducing suicide risk factors and changing the culture around seeking help for mental health conditions
  • Identifying at-risk students
  • Finding counseling services and other resources for varying levels of risk
  • Following policies and procedures to address student risk behaviors

Law professor Peter Lake and board-certified psychologist Paul Polychronis co-authored an opinion piece that warns colleges and universities to be realistic and not overreact to the Massachusetts court’s decision by focusing on assigning blame to avoid legal liability. Instead, our focus needs to be on changing the culture and perceptions around mental health, and encouraging students to seek help when they are in distress:

Keeping suicidal students safe and well is difficult work and requires something other than pressure to attain an unrealistic goal of zero suicides. Instead, prevention campaigns should focus on counteracting stigma and encouraging students to seek help. Care and compassion should guide us, not the fear of assigning blame where none exists. Being realistic will place higher education in the best position to perform this challenging work.

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