Concern over confidentiality -- and potential litigation -- further complicates the issue of suicide prevention on campus. "The issue is that there are two competing values," said Miller. "One is guarding somebody's confidentiality and the other is about doing something that may be helpful and potentially life-saving. From time to time, those decisions have to be made ... you don't want to do it frivolously. You should approach these decisions systematically, be reasonably clear in your own mind what your system is for doing this and do it consistently."
Miller believes there's been a trend toward greater documentation among psychiatrists in general but cautions that standardized forms, such as those used during intake interviews, are only as good as the information they contain. "I think that the fear of being sued has been on people's minds for decades, and I don't know that it's any different on college campuses," he said. "If there have been highly publicized cases, people take note of that and they do what they can to put systems in place to deliver the care more effectively. I don't think that necessarily has an impact on the number of suicides, but it may have an impact on people's comfort in giving the care and may make the delivery of care more rational in the sense that you have a better sense of why you're doing what you're doing."