Unit 7 Discussion

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Eisel v. Board of Education of Montgomery County was the first suicide case that was presented in court against school counselors. It involved a father, Stephen Eisel suing the Board of Education after his daughter, Nicole Eisel, committed suicide after her friends reported to school counselor, Deidre Morgan, what she intended on doing. Morgan then informed Nicole’s counselor, Dorothy Jones, of the allegations told to her. Jones then met with Nicole, who denied ever making any suicidal statements. Due to the denial of any suicidal ideations, Jones did not take any further actions. Within a week, Nicole and another classmate consummated their plan in what seemed to be a murder-suicide, where the classmate shot Nicole and then turned the gun on herself. Let’s dissect this case utilizing the ethical decision-making model: Step 1: Identify the problem In this scenario, the immediate problem is the allegations that Nicole intends to kill herself according to her classmates. Step 2: Consider the significance of the context and setting Does she need to be hospitalized? Does she have a plan and the means to complete the plan? As far as confidentiality goes, am I ethically responsible for talking to the parents? Do I believe Nicole in saying that these allegations are true, or should I continue to monitor her and carefully look for any potential signs of suicide? Seeing as her friends reported this to the other school counselor, Morgan, I would have met with these friends who first reported the allegations personally. This would have allowed me to get more details about the conversation that took place with Nicole and have a better sense of whether there could be any validity to the statements being reported by her friends. Step 3: Identify and utilize legal resources: The American Counseling Association (2014, Section B.2.a.) states that a counselor’s confidentiality does not apply when disclosure is required to protect clients from serious and foreseeable harm. Section B.5.b. (ACA, 2014) highlights counselors’ responsibility to parents and legal guardians of minors. The Texas Family Code Section 32.003 and 32.004 list instances where minors can consent to treatment without their parent’s consent, which includes being able to consent to counseling for suicide prevention, chemical or alcohol addiction or dependency, or sexual, physical, or emotional abuse (Brockway et al., 2022). The American Psychology Association (2017, Standard 3.10) also stated that when a person is unable to provide informed consent (such as a minor), a psychologist must consider the client’s best interest. The Health Insurance Portability and Accountability act of 1996 also allows covered entities to “disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat)” (OCR, 2022). Step 4: Consider personal beliefs and values My personal belief in breaking Nicole’s confidentiality is validated in the fact that I would truly believe that she could possibly harm herself, despite her denying the allegations. Although it may affect the therapeutic relationship, disclosing this information to her parents takes priority as it can possibly ensure her safety. I would say one of my core values, specifically when working

with minors, is the family unit and having them be involved in treatment as additional support to the client. Step 5: Develop possible solutions to the problem First and foremost, I would conduct a full suicide risk assessment on Nicole, whether she denies or confirms her friend’s allegations of her intentions to commit suicide. By completing the assessment, I can obtain additional details such as if she has a specific plan in place, the means to complete her plan, what her supervision at home looks like, etc. I can also discuss my limits of confidentiality with Nicole and encourage her to share this information with her parents. If Nicole refuses to tell her parents, I can then bring in the parents to speak to Nicole together and create a safety plan to minimize the risk of suicide. Step 6: Consider the potential consequences to several solutions If the suicide risk assessment determines that Nicole is in fact suicidal, she can be hospitalized. If she is in fact suicidal and I decide to take her word that she is not and she still decides to commit suicide, I can be held legally responsible. If I disclose this information to Nicole’s parents without her approval, it can further affect her mental health and cause her to isolate more, which in turn increases her risk for suicide. Step 7: Choose and implement a course of action If the suicide risk assessment concludes that Nicole is actively suicidal, I will make the decision to hospitalize her and inform her parents immediately. However, because this is in a school setting, even if the assessment states that she is passively suicidal, I will still make the decision to notify school administration as well as her parents of the risk of suicide. In this case, I can work with Nicole, her parents, and any other persons of support to create a safety plan and continue monitoring her throughout the school year. Step 8: Assess the outcome and implement change as needed If Nicole was hospitalized, is she on a treatment plan and/or medications? Will she benefit from medication management services? How is the relationship between Nicole and her parents after hospitalization, do they need additional support as a family? If she was not hospitalized due to being passively suicidal, what does her safety plan look like? Does she have enough supervision and support to keep her safe in case of suicidal ideations? Is monitoring her progress enough to deter any suicidal thoughts from reoccurring? The ending to this scenario is truly heartbreaking. I do believe that if the school counselor had taken additional steps to gain more details and bring in other persons of support, Nicole could have had a different fate. In cases such as this one, as a counselor I could have consulted the other counselor, Morgan, on her thoughts of what my next steps would be. I could have also consulted this information with the school principal so that I could be clear on school policies and procedures and what my duties entail in cases such as this one. References:

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