The issue of suicide, including prevention, intervention, and postvention, continues to be a problem on college campuses. For this study, data concerning a variety of issues related to college student suicide were collected from 1,865 students at four different universities. Incidence, risk factors, and potential solutions are described, as well as implications for mental health professionals in university settings.
I have three purposes in this article: (a) to briefly review the legal obligations a mental health professional has when working with a client who is talking about taking some action that could lead to his or her death, (b) to clarify the positions of the 4 major national mental health organizations regarding the acceptable roles of their members with clients who are discussing the possibility of receiving assisted death, and (c) to propose a set of guidelines for practice for mental health professionals working with clients who are considering assisted death that comport with the various laws and codes of ethics.
person's "decision-making capacity" 3 or, more broadly, whether the person has "impaired judgment." 4 The concerns about capacity and impaired judgment are so great that most model acts for assisted death suggest or require the involvement of a mental health professional to assess whether the person requesting assisted death is incapable or has impaired judgment. 5 For example, one proposal required a mental health professional to "evaluate the patient to determine that his or her decision is fully informed, free of undue influence, and not distorted by depression or any form of mental illness." 6 This article examines the issues of impaired judgment as well as the capacity to choose, and then to receive, PAD. Because the Oregon Death with Dignity Act, the only state law that allows PAD, has a provision for an assessment by a mental health professional about whether a person has the capacity to make a decision to request PAD and whether the person's judgment is impaired, 7 the article reviews dilemmas and suggestions for how assessments of capacity and impaired judgment can occur under the Act. 8 3 Capacity to form reasoned decisions is equivalent to "competence" but only a trier of fact (a judge or, if requested by the person, a jury) can make a legally binding determination whether a person is competent.
Scholars have based their understanding of college-student suicide in the United States largely on the study of European Americans, and therefore, its relevance to making culturally informed decisions with suicidal Asian American college students is unclear. This article explores aspects of suicide assessment potentially unique to Asian American college students and discusses possible ways to handle the process of breaking confidentiality that are more sensitive to Asian American needs. First, the authors briefly review issues of confidentiality, informed consent, and standards of care. Second, they examine several aspects of Asian American college students' experiences in the United States and of Asian cultural values. Specifically, the authors review acculturation and the experience of immigration, intergenerational relationships, collectivistic cultural values, the myth of the “model minority,” and perfectionism. Third, they offer culturally informed considerations for assessing suicidal risk and ways to manage breaking confidentiality. Finally, they suggest the Collaborative Assess-ment and Management of Suicidality model and the Suicide Intervention Response Inventory−2 as potentially useful tools for culturally sensitive work with Asian American college students.
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