Suicide Incident Referral Form

The text below is taken from the Student Code Part 1, Article 2: 

§ 2-102 MANDATORY ASSESSMENT

Suicide Incident Referrals

1. When the university is presented with a credible report that a student has threatened or attempted suicide, engaged in efforts to prepare to attempt suicide or has been psychiatrically hospitalized due to suicidal ideation, that student may be required to attend four sessions of professional assessment.
2. Procedures
   1. The attending or responsible university employee who becomes aware of facts stated in subsection (a)(1) above must submit a Suicide Incident Referral Form including the student’s name and circumstances of the student’s suicide incident.
   2. Members of the Suicide Intervention Team (SIT) will conduct an individualized clinical evaluation of the report to determine if assessment will be mandated. SIT will notify the Student Assistance Center (SAC) of their determination.
   3. The SAC will notify the student via their official University of Illinois email account of the requirement. This notification will include relevant deadlines; enforcement mechanisms for noncompliance, including but not limited to registration holds; and instructions for appealing (See subsection (c) below.).
   4. If the student is not subject to mandatory assessment, the SAC will contact the student via their official University of Illinois email account and provide them with information about relevant campus resources.

Appeals of Mandatory Assessments. A student may appeal an assessment mandated under subsections (a) or (b) above within three business days of the date they were notified of the requirement by submitting a written appeal to the Dean of Students (or designee). In reviewing an appeal, the Dean of Students (or designee) may consult with appropriate campus professionals. The Dean of Students (or designee) will render a decision as soon as is practicable. The decision of the Dean of Students (or designee) is final and not subject to further appeal.

We understand that your health care information, including counseling appointments, is personal. We are committed to maintaining the confidentiality of this information and providing you with information regarding our privacy practices. Information about your appointments at the Counseling Center is confidential and cannot be disclosed to others without your written consent. Any recorded information about your appointments at the Counseling Center will not be part of your academic record. The Counseling Center complies with state and federal laws regulating confidentiality as well as professional ethical codes. There are some exceptions to confidentiality, typically involving imminent risk of self-harm or abuse of others.

If you have any questions or concerns about the Counseling Center’s confidentiality policies, please contact the Therapeutic Services Coordinator at at 217-333-3704. The Counseling Center has chosen to adopt some of the provisions of the Health Insurance Portability and Accountability Act (HIPAA) because they represent excellent standards of professional practice in regards to privacy and confidentiality. The Counseling Center may use or disclose your protected health information (PHI) for treatment and health care operations purposes only with your written authorization. The Center may also use or disclose PHI for purposes outside of treatment or health care operations when your written authorization is obtained. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that the Counseling Center has relied on that authorization in providing services on your behalf.

Limits of Confidentiality

The Counseling Center may use or disclose PHI without your consent or authorization in the certain circumstances, including the following:

• Child Abuse – If your counselor has reasonable cause to believe a child known to him/her in his/her professional capacity may be an abused child or a neglected child, your counselor must report this belief in accordance with the Abused and Neglected Child Reporting Act.
• Adult and Domestic Abuse – If your counselor has reason to believe that an individual (who is protected by state law) has been abused, neglected, or financially exploited, he/she must report this belief in accordance with the Illinois Elder Abuse and Neglect Act.
• Serious Threat to Health or Safety – If your counselor believed that you present an imminent, serious risk of physical or mental injury or death to yourself, he/she may make disclosures he/she considers necessary to protect you from harm. If you communicate to your counselor a specific threat of imminent harm against another individual or if he/she believes that there is clear, imminent risk of physical or mental injury being inflicted against another individual, he/she may make disclosures that he/she believes are necessary to protect that individual from harm in accordance with the Illinois Mental Health and Developmental Disabilities Confidentiality Act.

​Complaints

Should you have questions or if you believe your privacy rights have been violated, you can file a complaint by contacting the Counseling Center at 217-333-3704 and requesting to speak with our Privacy Officer. The Counseling Center has policies that ensure all complaints are handled in a professional and ethical manner.

More information about your confidentiality rights and the Counseling Center’s privacy policies can be found in our NOTICE OF PRIVACY PRACTICES, which students receive at their initial appointment.

While many of our staff love animals and are pet owners, the Counseling Center is not able to provide assessments to document the need for an Emotional Support Animal (ESA).

ESAs are viewed under the Federal Housing Act (FHAct, 42 U.S.C.A. 3601 et seq) as a “reasonable accommodation” for those who have a physical or mental disability.

Guidelines and Documentation Requirements Related to ESAs 

Additionally, if you live in University Housing and want an ESA to live with you, you must be registered with Disability Resources and Education Services (DRES) and fill out their registration form. 

If you have not been diagnosed with a disability and want to be evaluated to see if you are eligible to have an ESA, you must find a mental health provider in the community to diagnose you and recommend that obtaining an ESA is a reasonable course of treatment given your condition.

To find a mental health professional in our area to help you meet this need, a good place to start is to contact your health insurance provider.  This link allows you to search for local therapists.