Addressing Students' MH Needs a Balancing Act for Colleges

American colleges and universities should adopt a consistent set of policies that encourage students with mental health problems to get treatment and make reasonable accommodations to permit them to remain in school, says a proposal from a leading mental health rights organization.

“Colleges and universities should be committed to the success of all their students, including those with mental health needs, and should know what to do when a student is in crisis because of a mental health problem,” according to the recommendations from the Judge David Bazelon Center for Mental Health Law in Washington, D.C.

The model policy lays out standards to guide university officials in reducing the stigma attached to mental health problems, find ways to get professional help for students, work to prevent suicide, ensure confidentiality, and prevent discrimination against students having psychiatric problems.

A psychiatrist familiar with campus mental health issues said the model policy represents a good starting point, but such policies must ultimately balance the health of students with general campus safety.

“The Bazelon document addresses a real need, because many campuses don't have any policies in place now,” said Jerald Kay, M.D., professor and chair of psychiatry at Wright State University in Dayton, Ohio. Kay is chair of the APA Corresponding Committee on Mental Health on College and University Campuses.

“There are many very good things about the report, but it comes down very heavily on the side of protecting the student and does not consider other issues such as the liability placed on school administrators,” he said in an interview.

Colleges and universities often vacillate between considering troubled students as health cases or disciplinary problems, he said.

An attorney familiar with higher education issues made a similar observation—that the document fails to address broader safety concerns sufficiently.

“From the perspective of college and university administrators, while the rights and safety of the student with mental health problems must be part of the picture, of perhaps greater importance is the responsibility for the safety and well-being of the campus community as a whole,” a state assistant attorney general (who is not from Virginia), told Psychiatric News. She requested anonymity because she is not authorized to discuss possible legal liability publicly.

The Bazelon Center has long emphasized the rights of individuals in mental health issues.

“Too often colleges and universities respond to students with mental illnesses in punitive ways, requiring them to leave or evicting them from school-sponsored housing,” said Bazelon Center senior staff attorney Karen Bower in a statement accompanying release of the document. “Such punitive measures discourage students from seeking help and isolate them from social and professional supports at a time of crisis, increasing the risk of harm.”

The Bazelon proposal states that counseling services, including emergency psychiatric services, should be available to students on campus or by referral to mental health resources in the community. Services should be provided on a voluntary basis, and students should have the right to decide whether to use them. In “exceptional circumstances, and as the law permits, [a university] may seek involuntary treatment of the student.”

Further, the university may refer students to counseling if they exhibit behavior that is likely due to depression or other mental illnesses or have informed others that they are contemplating suicide.

“I'm impressed by the fact that [the Bazelon statement stresses] the need for direct outreach if students don't seek treatment on their own,” said Kay. “That includes increased awareness and training for students, faculty, police, resident advisors, and administrators to help them recognize signs of mental illness and know what to do when they observe them.”

Barely mentioned in the proposal is any role for parents. It simply suggests that counseling centers “may encourage the student to consent to sharing information with the student's family or others.”

“Parents of students often feel disenfranchised and often complain that they are the last to know [about a student's psychiatric problems],” said Kay.

The policy also stresses that in the event of “a serious and imminent threat to safety,” the university may disclose information to emergency personnel or others, but is otherwise bound by confidentiality rules unless the student explicitly waives that right.

The policy also urges colleges and universities to “reasonably accommodate” students with mental health problems by permitting reduced course loads, letting them work from home, dropping courses, changing roommates, or postponing due dates for assignments. The university should grant a voluntary leave of absence to students who request one. More rarely, it may require an involuntary leave for students who cannot remain in school even with treatment and accommodations for their illness.

Any decision about an involuntary leave must, however, be made by a committee that includes the director of the campus counseling center to ensure that a mental health clinician's view is part of the discussion. Also, students must have the chance to reply to any such demand for involuntary leave, the policy states.

Further, the university must have provisions for reinstating students, although it may request an opinion from the treating psychiatrist or mental health professional about whether a student's condition has improved to the point at which he or she is able to return to campus.

Universities must consider that professional opinion but can also require a demonstration of a student's fitness to return, said Bower in an interview. Any decision to permit reinstatement should be based on the same considerations used in imposing leave, she said.

Nevertheless, the state assistant attorney general would prefer to err on the side of caution. “Virginia Tech, in a single day, changed the standard of care for university administrators,” said the attorney.“ I would rather defend a discrimination action brought by a student with mental illness who was removed from campus than defend the lawsuits for failing to provide a safe environment from the families of slain students and staff.”

Paul Appelbaum, M.D., chair of APA's Council on Psychiatry and Law, and Kay will form a small working group to further discuss the document and prepare suggestions for future APA action on the questions of campus mental health and safety.

The Bazelon Center's model policy is posted at<www.bazelon.org/pdf/SupportingStudents.pdf>.▪