The issue of when colleges should notify parents that their adult children may be suicidal remains fraught with legal, medical and ethical dilemmas. College policies, state laws and professional codes of conduct vary widely — and occasionally conflict.

Some mental health professionals call a recent Virginia Tech settlement the latest step in a trend they welcome: Threats to safety increasingly take precedence over preserving confidentiality. They emphasize that in many cases, involving parents is not only right but also helpful.

“There's some good evidence if someone is really sick that involving family in their treatment planning, the medication, helping them stay on track, are really good things to do,” said Greg Eells, director of counseling and psychological services at Cornell University in New York, which has changed several policies to make notifying parents more common. I think the [Virginia Tech settlement] is kind of affirming that.”

That settlement centered on the suicide of Virginia Tech senior Daniel Kim who shot himself in the head. His family sued, arguing the school should have informed them of his suicidal tendencies and settled with the school for $250,000, plus an endowed scholarship in his name. His father William Kim also insisted that the agreement include language requiring Virginia Tech to notify parents of a potentially suicidal student unless it documents a reason not to do so.

Many remain wary of top-down pressure on counselors to notify parents as the default option, even if such policies are well-intentioned and allow exceptions. Many students have just passing thoughts of suicide. Also, relationships with parents may be part of the problem. Involving them too readily might discourage some people from getting help, or complicate treatment once they do.

“The less flexibility we have, it actually compromises care,'' said Mary-Jeanne Raleigh, director of counseling services at St. Mary's College in Maryland and president of ACCA, the American College Counseling Association. Overly rigid policies mean, she said, “I can't review what is best for the individual standing in front of me because the law is saying you have to x, y and z.”

Suicide is the second leading cause of death for college students, behind automobile accidents. A 2010 survey of counseling center directors found at least 133 college students had taken their lives in the previous year. The better indicator is probably the rate, estimated at about six to 7.5 per 100,000, though that's only about half the suicide rate for similarly aged people not in college.

But while the research highlights the danger, it also sheds light on why these are tough calls for colleges. Warning signs aren't always as black-and-white as they were at Virginia Tech. A milder form of suicidal ideation — fleeting hopelessness or thoughts about death — is common.