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