Comments on Wall Street Journal Story About the Aftermath of Suicide

On March 24, 2007 the Wall Street Journal ran a story on page one called "After a Suicide, Privacy on Trial - A jury weighs whether Chuck Mahoney's college should have told his parents more" by Elizabeth Bernstein. It generated these follow-up comments:

---

Student Suicides: Privacy Rules Must Be Tempered by Common Sense April 16, 2007

Your moving article about the college student's suicide (After a Suicide, Privacy on Trial) underlines central dilemmas in working with young adults in crisis. The pressures faced by clinicians working with such promising young people at risk are enormous. Privacy is very important for adolescents who are trying to become independent. Yet while the rigid legal line around confidentiality and adult status preserves this privacy and protects clinicians working with older adolescents, it may bypass the developmental crises faced by these young people and the social and interpersonal context in which these crises arise.

[Letters]

Confidentiality is a real right of our patients. But clinicians have the authority to break it in a crisis. What's at stake is the potential ending of a treatment relationship either because of the clinician's overriding the patient's right to confidentiality in a way that ruins the treatment alliance or because of the patient's death. The clinician's commitment is to a workable treatment.

Edward R. Shapiro, M.D.
Medical Director, CEO
Austen Riggs Center
Associate Clinical Professor of Psychiatry
Harvard Medical School
Stockbridge, Mass.

The main message of this tragic episode isn't about privacy, but about alerting and instructing the people who have the natural responsibility to take care of those who are acting strangely: family members and good friends. Stop worrying about being overprotective, it is much worse to be underprotective.

Dave M. O'Neill
Adjunct Professor of Economics
Baruch College
The City University of New York New York

---

Depressed and suicidal students often feel so because they think that they didn't live up to their family's expectations for their school performance. Others become depressed when they aren't able to negotiate a critical transition from an interdependent home environment, whether warm or conflicted, to an independent but sometimes lonely and pressure-ridden life in college. In either case, treating suicidal students without family involvement is nonsensical since such treatment purposefully excludes people who are at the core of the issues causing the student's depression. These are usually the same people who are essential for the treatment success.

New family-oriented treatments for mood disorders, such as family-focused treatment and family-inclusive treatment, help both the patients and the families. Given the high stakes in cases of suicidal students, contacting families during their treatment should be either mandatory or, at minimum, at the discretion of the treating mental-health professional. Possible family contacts under exceptional circumstances should be discussed and agreed upon with all student patients at the beginning of their treatment. This way we'll save a lot of student lives and a lot of families.