Psychiatrists who treat college students living long distances from home
and from their office must be aware of the potential risks involved with
practicing from afar, say risk management experts, risks that include
licensure and crisis-management issues.
Risk managers from Professional Risk Management Services (PRMS), the
administrator of the APA-endorsed psychiatrists' liability insurance program,
suggest that if possible, hometown psychiatrists should refer college students
to mental health treatment either on campus or in the community where the
college is located.
"Maintaining the standard of care gets more difficult the farther the
psychiatrist is from the student," noted Donna Vanderpool, M.B.A., J.D.,
assistant vice president of risk management at PRMS, in an interview."
The bottom line is that psychiatrists need to keep the students and
those around them safe."
Psychiatrists who choose to continue treating the student remotely,
however, said Martin Tracy, J.D., president and CEO of PRMS, should have on
hand a list of people to call should the student have a mental health crisis
while at school.
For instance, psychiatrists may want to obtain the phone number for campus
police, the name and number of roommates and a resident advisor, and the
number of a local hospital, Tracy noted.
If hometown psychiatrists are providing treatment to students across state
lines, psychiatrists should be aware of potential issues that can crop up
around licensure, according to Jacqueline Melonas, R.N., M.S., J.D., vice
president of risk management at PRMS.
She advised contacting both states' medical boards to determine whether
treating the student across state lines is considered practicing without a
license and, if so, whether a limited license is available.
In addition, she pointed out that home-town psychiatrists treating students
who are away at college should plan ahead for potential mental health problems
by exploring mental health services available on campus or in the community
where the campus is located.
In some cases, the student's mental health care is managed by a
campus-affiliated psychiatrist during the academic year and the hometown
psychiatrist during vacations and summer months. In these cases, the two
clinicians should communicate closely and coordinate care, Vanderpool
In an age in which need for mental health services among college students
is increasing, it is crucial that students with mental health problems have
adequate treatment, the risk managers noted.
A growing body of evidence points to the fact that increasing numbers of
college students are arriving on campuses with mental health problems: data
from a 2004 survey by the American College Health Association show that nearly
half of college students report feeling so depressed at some point that they
have trouble functioning, and nearly 15 percent meet criteria for clinical
depression at some point in their college years.
In addition, according to combined data from the 2002 to 2005 National
Surveys on Drug Use and Health, 57.8 percent of full-time college students
under age 21 used alcohol in the prior month, 40.1 percent engaged in binge
drinking, and 16.6 percent engaged in heavy drinking.
Documentation, risk managers' favorite mantra, becomes crucial for
psychiatrists treating students from afar. "Documenting your
decision-making process and attempts to contact other providers' regarding the
student's care permits a subsequent provider, jury, or medical board to
understand what happened with the student's treatment and why,"
Questions about confidentiality of mental health information often emerge
in the psychiatric treatment of college students, Vanderpool noted.
By law, students aged 18 and older are entitled to make their own decisions
about who may access their medical information. However, parents, who may be
paying students' tuition, often expect to be privy to the information, as may
officials at the college, Vanderpool said.
"Psychiatrists should understand what the school policy is regarding
confidentiality of students' medical records or mental health
information," said Vanderpool. One major exception to doctor-patient
confidentiality is when the student is in danger of harming himself or herself
College psychiatrists treating students exclusively in campus mental health
centers must also strive to ensure that graduating students or those who leave
campus and receive treatment elsewhere are informed of the campus
psychiatrist's treatment recommendations, the risk managers stated."
Times of transition are the riskiest in terms of mental health
issues," noted Melonas.
It is also helpful for psychiatrists treating college students to promote
mental health prevention programs available to students on campus.
Examples include screening and treatment programs such as the Using the
Collaborative Care Model to Improve Depression Care on College Campuses
(Psychiatric News, April 6), Active Minds on Campus (Psychiatric
News, September 19, 2003), and the National Alliance on Mental Illness on
"The bottom line" for psychiatrists treating college students,
Vanderpool said, "is to deliver good clinical care and to document the
More information about risk management for psychiatrists is posted