Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies.

PURPOSE OF REVIEW: We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures. RECENT FINDINGS: Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

Evaluation and Management of Mental Health Disability in Post-secondary Students.

PURPOSE OF REVIEW: Due to the interdisciplinary nature of mental health disability in post-secondary educational settings, there is limited information available in the general psychiatric literature. This paper aims to familiarize psychiatrists with issues surrounding mental health disability in post-secondary educational settings. In this manuscript, we review critical aspects of the evaluation and management of post-secondary students who may be entitled to academic accommodations as a result of impairment from psychiatric diagnoses. We discuss common misconceptions about mental health impairment and best practices to mitigate its burden. We review relevant legislation and literature from psychiatric, psychological, and higher education journals and include multidisciplinary expert opinions. RECENT FINDINGS: Mental illness is increasingly common in the post-secondary student population. When symptoms are severe, they can lead to academic impairment or disability. Nationwide data suggests an increase in post-secondary students requesting accommodations for mental health-related impairments. Recent guidelines from the American Psychiatric Association and The Jed Foundation aim to familiarize mental health providers, evaluators, administrators, students, and their families with best practices related to evaluating and managing mental health disability in post-secondary educational settings. Evaluating, accommodating, and managing mental health disability during the post-secondary years are complicated processes. Legislation and nuanced evaluations can guide evaluating psychiatrists and administrators in recommending appropriate accommodations. By being knowledgeable about relevant legislation, best practices for evaluations, and available student resources, psychiatrists will be able to collaborate effectively with all stakeholders.

The importance of hopelessness among university students seeking psychiatric counseling.

Hopelessness is a clinically important state relative to morbidity and suicide risk among university students. We examined its role in relation to presenting concerns, diagnosis, psychopharmacologic treatment and spiritual orientation among students seeking treatment at a university counseling center. The most commonly identified concern was anxiety, followed by stress and depression. Eighty-two percent were given a DSM IV diagnosis. Hopelessness was higher among students dually diagnosed with anxiety and depressive disorders and those who were started on psychiatric medication. Spirituality was inversely correlated with hopelessness and constitutes a personal characteristic warranting further investigation. The concerns bringing students to counseling, the rates of DSM IV diagnosis and the use of psychiatric medication suggest a preponderance of psychopathology over developmental or situational concerns that may be more prominent than has been noted in the counseling literature. In this regard, hopelessness appears to be an important feature even beyond its relationship to suicidality and merits attention and evaluation in student counseling.