...'though still no recognition of trauma and its impact on faculty, themselves...
April 19, 2007
Laws Limit Options When a Student Is Mentally Ill
By TAMAR LEWIN
Federal privacy and antidiscrimination laws restrict how universities can deal with students who have mental health problems.
For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.
Nor is knowing when to worry about student behavior, and what action to take, always so clear.
“They can’t really kick someone out because they’re writing papers about weird topics, even if they seem withdrawn and hostile,” said Dr. Richard Kadison, chief of mental health services at Harvard University. “Most state laws are pretty clear: you can only bring students to hospitals if there is imminent risk to themselves or someone else, so universities are in a bit of a bind that way.”
But, he said, some schools do mandate limited amounts of treatment in certain circumstances.
“At the University of Missouri, if someone makes a suicide attempt, they mandate four counseling sessions, for example,” said Dr. Kadison, an author of “College of the Overwhelmed: The Campus Mental Health Crisis and What To Do About It.”
Universities can find themselves in a double bind. On the one hand, they may be liable if they fail to prevent a suicide or murder. After the death in 2000 of Elizabeth H. Shin, a student at the Massachusetts Institute of Technology who had written several suicide notes and used the university counseling service before setting herself on fire, the Massachusetts Superior Court allowed her parents, who had not been told of her deterioration, to sue administrators for $27.7 million. The case was settled for an undisclosed amount.
On the other hand, universities may be held liable if they do take action to remove a potentially suicidal student. In August, the City University of New York agreed to pay $65,000 to a student who sued after being barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt.
Also last year, George Washington University reached a confidential settlement in a case charging that it had violated antidiscrimination laws by suspending Jordan Nott, a student who had sought hospitalization for depression.
“This is a very, very difficult and gray area, when you take action to remove the student from the campus environment, versus when you encourage the student to use the resources available on campus,” said Ada Meloy, director of legal and regulatory affairs at the American Council on Education. “In an emergency, you can share certain information, but it’s not clear what’s an emergency.”
Ms. Meloy estimated that situations complicated enough to involve a university’s lawyers arise, on average, about twice a semester at large universities.
While shootings like the one at Virginia Tech are extremely rare, suicides, threats and serious mental-health problems are not. Last year, the American College Health Association’s National College Health Assessment, covering nearly 95,000 students at 117 campuses, found that 9 percent of students had seriously considered suicide in the previous year, and 1 in 100 had attempted it.
So mental health experts emphasize that, whatever a college’s concerns about liability, the goal of campus policies should be to maximize the likelihood that those who need mental-health treatment will get it.
“What we really need to do is encourage students to seek mental health treatment if they need it, to remove any barriers to their getting help, destigmatize it, and make it safe, so they know there won’t be negative consequences,” said Karen Bower, a lawyer at the Bazelon Center for Mental Health Law in Washington, who represented Mr. Nott.
With the Virginia Tech killings, many universities are planning to remind faculty members of their protocols. “We’re actually going to go ahead and have the counseling service here do a session for all our instructors and faculty on what to look for, what the procedures are, and what the counseling center can do,” said Shannon Miller, chairwoman of the English department at Temple University.
At Harvard, Dr. Kadison said, dormitory resident assistants watch for signs of trouble, and are usually the first to become aware of worrisome behavior — and to call a dean.
“The dean might insist that they get an evaluation to make sure they’re healthy enough to live in a dorm,” he said. “If it’s not thought that they’re in any immediate danger, they can take or not take the recommendation.”
Last month, Virginia passed a law, the first in the nation, prohibiting public colleges and universities from expelling or punishing students solely for attempting suicide or seeking mental-health treatment for suicidal thoughts.
“In one sense, the new law doesn’t cover new territory, because discrimination against people with mental health problems is already prohibited,” said Dana L. Fleming, a lawyer in Manchester, N.H., who is an expert on education law. “But in another sense, it’s ground-breaking since it’s the first time we’ve seen states focus on student suicides and come up with some code of conduct for schools.”
College counseling services nationwide are seeing more use.
“We’re seeing more students in our service consistently every year,” said Alejandro Martinez, director for counseling and psychological services at Stanford University, which sees about 10 percent of the student body each year. “Certainly more students are experiencing mental illness, including depression.
“But there’s also been a cultural shift,” Mr. Martinez said, “in that more students are willing to get help.”
College officials say that a growing number of students arrive on campus with a history of mental-health problems and a prescription for psychotropic drugs. But screening for such problems would be illegal, admissions officers say.
“We’re restricted by the disabilities act from asking,” said Rick Shaw, Stanford’s admissions director. “We do ask a question, as most institutions do, about whether a student has been suspended or expelled from school, and if they have been, we ask them to write an explanation of it.”
Federal laws also restrict what universities can reveal. Generally, the Family Educational Rights and Privacy Act, Ferpa, passed in 1974, makes it illegal to disclose a student’s records to family members without the student’s authorization.
“Colleges can disclose a student’s private records if they believe there’s a health and safety emergency, but that health and safety exception hasn’t been much tested in the courts, so it’s left to be figured out case by case,” Ms. Fleming said.
And the Health Insurance Portability and Accountability Act prohibits the release of medical records. “The interaction of all these laws does not make things easy,” she said.
I hope we can take the "right" lessons from this. A shift away from an ethical handling of privacy issues would be bad. As I mentioned in my last post, the right "mix" of ethics and empathy: that's the ticket.
April 19, 2007
The Killer in the Lecture Hall
By BARBARA OAKLEY
THE sticky note on my door was wiggling. It was a gift from a student.
Glued to the middle of it was a cockroach.
Don’t get me wrong. It wasn’t that I was an unpopular professor. To the contrary — according to student evaluations, I might as well have had a sign on my forehead that said “Kindly.”
I was told later that the cockroach was a symbol of love from — well, let’s call him Rick. Rick had recently moved into the lab across the hall from my office, where he spent the night in a sleeping bag under one of the benches.
Rick, who had been a student for more than a decade, sometimes whiled away his time discussing guns and explosives with some of the more munitions-inclined faculty members. He admitted that he kept his basement stocked with a variety of “armaments.”
Sometimes I wished I had an armament, although, like Virginia Tech, my university does not allow firearms on campus. I wished that because, not only did Rick attach love-cockroaches to my door and live across the hall from my office and possess a small armory, but Rick watched me all the time. Sometimes he followed me out to my car — just to make sure I was safe.
When I complained about Rick to the dean of students, I was told there was nothing to be done — after all, “students have rights, too.” Only after appealing to that dean’s boss and calling a raft of fellow professors who had also come to fear Rick’s strange behavior was I able to convince the administration to take grudging action; they restricted his ability to loiter in certain areas and began nudging him toward the classes he needed to graduate.
In a strange way, I could see the administration’s point. Rick looked fairly ordinary, at least when away from his sleeping bag and pet cockroaches. It must have seemed far more likely that
Rick could sue for being thrown out of school, than that I — or anyone else — could ever be hurt.
The easiest path, from their perspective, was to simply get me to shut up.
Many professors have run across more than their share of Ricks. At least one Virginia Tech professor noticed that Cho Seung-Hui, who killed 32 people on campus on Monday, was potentially dangerous and did her best to warn the administration and the police. (So did at least two female students.) But there is only so much a teacher can do — “students have rights, too.”
It’s a simple fact that, for every deranged murderer like Mr. Cho there are thousands more oddballs just below the breaking point. I know one quasi-psychopathic incompetent, for example, who remained on the campus payroll for over a dozen years simply because his supervisor was afraid of being killed if he was fired.
It’s long been in fashion to believe that people are innately good, and that upbringing and environment are responsible for nasty personalities. But research is beginning to show that mean, sometimes outright evil behavior has a strong genetic component. Some of us, in other words, are truly born bad.
Researchers at King’s College London have recently determined that if one identical twin shows psychopathic traits, the other twin, who coincidentally shares precisely the same set of genes, has a very high probability of having the same psychopathic traits. But among fraternal twins, who share only half their genes, the chance that both twins will show psychopathic traits is far smaller. In other words, there is something suspiciously psychopath-inducing in some people’s genes.
What could it be? Medical images of the brain give tantalizing clues — the amygdala, the “fight or flight” decision-making center of the brain, may be smaller than usual, or some areas of the brain may glow only dimly because of low serotonin levels. We may not know precisely what set Mr. Cho off, but we are beginning to home in on the unusual differences in certain neurochemistries that can make people act in bizarre and dysfunctional ways.
Still, the Virginia Tech shootings have already led to calls for all sorts of changes: gun control, more mental health coverage, stricter behavior rules on campuses. Yes, in a perfect world, there would be no guns, no mental illness and no Cho Seung-Huis. But the world is very imperfect.
Consider that Britain’s national experiment with gun-free living is proving to be a disaster, with violent and gun crime rates soaring.
In other words, most of the broad social “lessons” we are being told we must learn from the Virginia Tech shootings have little to do with what allowed the horrors to occur. This is about evil, and about how our universities are able to deal with it as a literary subject but not as a fact of life. Can administrators and deans really continue to leave professors and other college personnel to deal with deeply disturbed students on their own, with only pencils in their defense?
Barbara Oakley, a professor of engineering at Oakland University, is the author of the forthcoming “Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed and My Sister Stole My Mother’s Boyfriend.”