Net Exchange Response
Title: Teacher’s concern about a suicidal student
Date Posted: 11/15/2010

Question: “Does a CA public high school employee (teacher) have a legal obligation to inform a minor's parents when their child informs them that she has made a suicide attempt? In this case, a school counselor was consulted and the student's parents were informed that the student had attempted to "hurt themselves," but the full extent of the effort, as well as the manner in which it was attempted, were not fully disclosed to the parents. The parents have put the student in outside therapy, but the student has stated that until she turns 18 years of age, she will not be 100% honest with the therapist with regard to the suicide attempt because the therapist told her that she would have to disclose this information to her parents. Does the teacher have a legal obligation to inform the parents of the true extent of the situation? Any information you could provide would be most appreciated.”

Response: Thanks for contacting us with your question. In addition to the question of legality, there are complicated ethical matters involved. Because of this, we have sent a query to a range of colleagues to ask how they would respond. Below is our response and some related resources; these are followed by a sample of the responses from others.

While those of us with in student support/health/mental health credentials and licenses have a clear mandate to report when a student is a danger to self or others, the details involved in mandated reporting by teachers often is less clear. What is clear is that when a student confides in a teacher or other school staff, teachers usually feel caught between respecting the trust the student has placed and doing what may seem to be in the best interest of the student. In our work, we have suggested that working with the student to share their concerns with others (especially their parents) is an alternative to "keeping the secret" or "violating the trust."

See: Confidentiality and Informed Consent
http://smhp.psych.ucla.edu/pdfdocs/confid/confid.pdf

You might also want to take a look at the resources on the California Department of Education Youth Suicide Prevention page (here is a portion of the resources there)
http://www.cde.ca.gov/ls/cg/mh/suicideprevres.asp

  • >“Youth Suicide Prevention – A listing of resources to assist school districts with the concerns about youth suicide prevention, intervention, and postvention. To assist school districts with the concerns about youth suicide, the following resources are available for dealing with suicide prevention, intervention, and postvention (sometimes referred to as "aftermath"). Some sites provide factual data and others contain programs. For more Web information, contact the coordinator for pupil services in your school district or county office of education. Counseling and student support specialists (school counselors, school psychologists, school social workers, and school nurses) and local mental health specialists should be consulted for individual student referrals.”

  • >“Legislation
    • >>Education Code Section 41533 – This statute authorizes school districts to use a portion of their Professional Development Block Grant funding to pay for suicide prevention training for school teachers. The teacher training is not to exceed two hours and may occur during a regularly scheduled in-service day.
    • >>Education Code Section 49604 – This statute authorizes the State Superintendent of Public Instruction to encourage each middle school, junior high school, and high school to provide suicide prevention training to each school counselor at least one time while employed as a counselor.”

  • >“Publications -- Mental Health Services Act Suicide Prevention California Strategic Plan for Suicide Prevention The Department of Mental Health has several initiatives related to suicide prevention. These include the development of a Suicide Prevention Plan and other state initiatives related to suicide prevention.”

  • >“Youth Suicide-Prevention Guidelines for California Schools – The guidelines are available to assist schools to develop and implement plans for youth suicide prevention, intervention, and aftermath. The guidelines blend information from a variety of expert sources and are intended to help school communities in their school planning and prevention efforts. Counseling, student support specialists, and local mental health specialists should be consulted for planning and implementing school plans or for individual student referrals regarding youth suicide.”

  • >“Youth Suicide Prevention School-Based Guide”

Here are some of the responses we received from others:

(1) “There are several issues here which includes FERPA, CA Education Code and CA mental health law:

  • a. Under FERPA (Family Educational Rights and Privacy Act)which covers the school, school personnel may share their "general knowledge" of students to parents as well as any education records in regards to minors. So school personnel would have an obligation to disclose to parents information about the student's suicide attempt, particularly as it relates to protecting the minor student. There are several instances where parents have sued under FERPA to obtain information about their adult children and where schools did not protect their children. Schools should be familiar with their legal obligations under FERPA.

  • b. The CA Education Code covers school counselors under Section 49600. Information shared with the school counselor by student or parent is confidential, except when the counselor has cause to believe disclosure is necessary to "avert a clear and present danger to the health, safety, or welfare of the pupil" or anyone else associated with the school community. So, the counselor, I believe, can disclose.

  • c. Regarding mental health issues, there are CA codes covering the mental health question in this case described below.
    • (1) The exception to confidentiality due to suicidal threat, so the therapist can disclose to parents
    • (2) But, Welf. & Inst. Code Section 317 says a child who is over 12 years of age, may invoke the psychotherapist-client privilege so case law may support the therapist not sharing information about what is going on in therapy.
      (In re DANIEL C.H. (1990) 220 Cal.App.3d 814 & In re Mark L. (2001) 94 Cal. App. 4th 573)
    • (3) Cal. Health & Safety Code §§ 123115(a)(2). says parents do not have an absolute right to see their child’’s mental health records. Under state law, providers may refuse to provide parents or guardians access to a minor’’s medical records when "the health care provider determines that access to the patient records requested by the [parent or guardian] would have a detrimental effect on the provider’’s professional relationship with the minor patient or the minor’’s physical safety or psychological well -being."
    • (4) Family Code section 6924 (d) The mental health treatment or counseling of a minor authorized by this section shall include involvement of the minor's parent or guardian unless, in the opinion of the professional person who is treating or counseling the minor, the involvement would be inappropriate. The professional person who is treating or counseling the minor shall state in the client record whether and when the person attempted to contact the minor's parent or guardian, and whether the attempt to contact was successful or unsuccessful, or the reason why, in the professional person's opinion, it would be inappropriate to contact the minor's parent or guardian.

So, here it is. It appears that the school, the school counselor, and therapist should all get clarity about their respective legal obligations. This is a tricky case.”


(2) “The National Association of School Psychologists has a couple handouts that might be helpful that are available to the public. See these links:

http://www.nasponline.org/resources/principals/Suicide%20Intervention%20in%20Secondary%20Schoools%20NASSP%20Oct%202006.pdf

http://www.nasponline.org/publications/spr/pdf/spr382millerintro.pdf

(3) “I consulted with our legal and ethical chairpeople about this. Both agreed it is important for the teacher/school counselor to understand that they need to be forth coming when someone’’s life is at stake. They are putting themselves in some serious jeopardy legally and ethically by not disclosing, not to mention the jeopardy for the student. One said to run don't walk to the phone and let parents know the extent of the danger.”

(4) “While teachers may not have a “legal” responsibility to share the details of the previous attempt, they certainly have a professional and/or ethical responsibility. Perhaps I would have recommended that the counselor get a release of information signed by the parent so they can at least disclose all the information to the therapist including the student’’s plan NOT to be totally honest with the therapist.”

(5) “The problem is that each state and local district have policies that vary. I always advise that you have to follow school policy. Find the policy and follow it. Secondly I would suggest that the school do an extensive threat assessment. I would suggest using the Petra for this assessment.”

(6) “Each state and quite possibly each district has their own codes about this. The NYC DOE regs state that the teacher must alert the parent if the teacher finds out first hand. Only if alerting the parent would put the child in harms way would this not happen. The regs have the principal as the ultimate decision maker. If this child was seen by a mental health provider on-site, I think, if warranted the provider would do the same.”

(7) “While I am not 100% sure about the teachers responsibilities I am sure that a school counselor or school psychologist would be required to inform the parents of the fact the child, who at least has in the past been suicidal, had decided not to tell his or her therapist about future suicidal ideation. I also know that in CA there was a middle school teacher who was sued after learning of a students suicidal ideation and not informing the parents (the specific case escapes me at the moment). For the teacher I guess my recommendation be that she or he tell the parent. There is nothing preventing her from doing so and there are reasons to do so. Again if this was a school psychologist asking this question I would say that they have very little choice here. Short of a situation where the suicidal ideation is due to child abuse they must inform the parents (in the case of child abuse the obviously call CPS).”


Feedback

(1) “I recognize that this is a difficult situation however, when a students life is at stake, it is staff responsibility to make sure, to the best of their ability, that the student get help. In training I provide to teachers and other staff, I recommend, in the beginning of the year, they be forthcoming and very clear with students by letting students know that if the teacher is told something that causes them to think the student is going to hurt themselves, another person, or is in danger, the teacher would be reporting this information to an administrator , social worker, psychologist or the students counselor. The person contacted would make an assessment as to next steps regarding who then, if anyone, needs to be contacted. I encourage the teachers/staff to explain to the students why they feel this needs to be reported so the students know that if they confide in a teacher , they know that it will be reported to others and that the student is then not feeling betrayed by the teacher/staff member. Setting clear boundaries around this issue and reviewing it a few times a year can be very effective.”

(2) “A teacher has an obligation to notify parent, counselor, administrator, CPS or whomever his/her employer has indicated is school policy for the situation. This will vary from district to district. In LA Unified, a form called a RARD is filed and a counselor is called in to follow through on the interventions. I am a licensed psychotherapist and an experienced mental health provider as well as a practicing school nurse. I can tell you, as you can well imagine, that many times the student changes or frankly denies the report given by teacher, counselor, etc. Letting parents know that they might ‘hurt themselves’ seems legally more than adequate as the teacher is not functioning as mental health official. The teacher's responsibility, again, was to follow whatever district protocols were in place. You mention the ‘true extent of the situation.’ It is my understanding that that could only be fully assessed and determined by a psychiatrist or a PET team. District guidelines would also stipulate as to the teacher's disclosure guidelines to parent. All teachers are mandated CPS reporters so no confidentiality is granted for any attempts, suspected attempts, or any concerns that a student may be in danger in any way.”

(3) “Clearly, parents cannot act to protect their children if they do not know their children are in danger. In the case [cited], a disclosure was made that did result in the student entering therapy. However, the disclosure was partial. Typically, when a disclosure is made without consent to prevent harm to someone, the expectation is that only that information that is necessary to prevent the harm is to disclosed and the disclosure is to be made only to someone who has the capacity to intervene and prevent the harm. So, the school counselor could perhaps justify the limited disclosure. However, from the limited information, it could be that the school counselor would need to re-engage this situation to manage some unintended consequences (i.e., the student’s lack of cooperation in the therapy).”

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UCLA Center for Mental Health in Schools
Dept. of Psychology, P.O.Box 951563, Los Angeles, CA 90095.
tel: (310)825-3634
email: Linda Taylor ~ web: https://smhp.psych.ucla.edu