Use of the Suicide Incident Referral Form

If a suicide plan has been enacted, call 911 immediately!

Suicide Incident Referral Form

Experience has shown that many students are initially reluctant to discuss suicidal ideation with a counselor and, as a result, may not follow through with First Responder referral. To ensure follow through, a Suicide Incident Referral Form may be filed with the Dean of Students. The Dean will contact the student to arrange a meeting to review the referral to determine its accuracy and discuss the incident reported on the form.

If the referral information appears to warrant mandated assessment, the Dean will require a three-hour professional assessment of suicide risk with a member of the Suicide Prevention Team of CAPS. The emphasis is to ascertain risk and offer appropriate treatment services or referral for services in the larger community.

Students will be contacted by a member of the CAPS Suicide Prevention Team within 24-hours of receiving a referral from the Dean of Students or Director of Residence Life so that an appointment may be scheduled to begin the assessment at the first opportunity.

Assessments by the Suicide Prevention Team are confidential. The CAPS staff will limit contact with the Dean to information pertaining to the student’s compliance with the referral. No clinical information will be shared and records will be kept separately from academic and disciplinary records.

Use of the Suicide Incident Referral Form is an option for faculty and staff. It will prove most helpful when students are least cooperative and reluctant to seek professional help, even when urged to do so.

Nothing in this process co-opts the professional responsibility of taking immediate action when there is evidence that the student constitutes an imminent threat to him or herself or others.

If a suicide plan has been enacted, call 911 immediately!