College administrators around the country have Virginia Tech on their
minds, and their worries could lead to a compounding of last spring's campus
shooting, legal scholar Gary Pavela, M.A., J.D., told psychiatrists gathered
at APA's September Components Meeting in Washington, D.C., last month.
"One of the great tragedies, which has not yet unfolded, would be for
faculty members to take counsel of their fears and retreat from
students," said Pavela, director of judicial programs at the University
of Maryland. In fact, what is now needed is better cross-generational
communication to counter the disconnection between students and the people who
teach them and run their colleges.
Pavela spoke to a combined meeting of APA's Council on Psychiatry and Law
and Committee on Judicial Action. Representatives of the Corresponding
Committee on Mental Health on College and University Campuses, including its
chair, Jerald Kay, M.D., also took part in the meeting.
The discussion, which focused on student suicide, was the starting point
for possible APA actions to help colleges deal with difficult issues at the
intersection of law and college mental health, said Paul Appelbaum, M.D.,
chair of the council. Eventually, the process might lead to research
documents, guidelines, or position papers to help college administrators,
health providers, and attorneys connect better with students and prevent
suicide and other tragedies.
Despite some high-profile cases, the suicide rate among college students is
roughly half that of an age-matched community sample, wrote Appelbaum in the
July 2006 Psychiatric Services. Perhaps 10 percent of college
students surveyed in two studies said that they had though about suicide, 1.5
percent said they had attempted it, but only 0.1 percent had actually
Some recent court cases, wrote Appelbaum, "have left many college
administrators fearful of their liability should any suicide occur on
However, too often the response to a student in crisis has been harsh and
punitive. Students have been expelled from their universities after
voluntarily seeking help, said another speaker, Karen Bower, J.D., senior
staff attorney at the Bazelon Center for Mental Health Law in Washington, D.C."
Schools artificially try to wedge behavior onto a disciplinary
Even if a student remains on campus and enters treatment, some schools
require that the counselor report session attendance and content to the dean
or other administrator, a violation of confidentiality that can leave students
feeling coerced into therapy, betrayed by the counseling center, and hesitant
to get any treatment, she said.
"There are a lot of indications that colleges want students with
mental illnesses to just go away and not come back until they're
'cured,'" she said.
Kicking students out of school may be the worst possible alternative,
especially for a student who wants help, she continued. Being at college
offers structure and a social network that, combined with treatment, can be
conducive for recovery.
Pavela recommended that college administrators take several steps to better
address students' needs and at the same time reduce their liability.
"It is medically, legally, and therapeutically right to hold people
accountable for their actions, especially with resistant students," said
Pavela. "It helps students see the need for help. I tell administrators
to hold them accountable for threatening words or gestures but not to leap
immediately to expelling them."
For a start, he said, administrators should talk to high school principals,
who by now are familiar with post-Columbine research and legislation on
addressing and preventing school violence.
Also, college officials should not wait passively for students to walk into
the counseling or health center. Staff in those offices must reach out to
Administrators should move from trying to profile suicidal or dangerous
students to a "threat assessment" model of intervention, in which
all interested parties discuss the students' actions and behavior.
Preparations for times of crisis must begin long before, involving faculty,
administrators, counselors, students, and sometimes the police.
"You need a candid conversation on campus about confidentiality and
what it means, and you need to get students involved in that conversation, he
Faculty members need help in understanding how to neither overreact nor
underreact when they spot students engaging in troublesome behavior or making
a suicide reference in a paper, and guide them to the counseling center.
He also believes in a role for an administrative (but not disciplinary)
process that induces treatment by holding students with suspected mental
health problems responsible for disruptive, objective actions.
Some large universities are already looking at creative ways to keep
students enrolled while they are addressing the students' problems, he
Small colleges may have an advantage because they can get to know their
students better, work with them, and bring them to point where they are
willing to tell their parents about their problems, said Bower. "These
institutions want to support students, not turn them in."
Pavela suggested that colleges that do their utmost to keep depressed or
otherwise mentally ill students in school can reap another benefit.
"I would argue for this approach in the context of diversity,
analogously with racial diversity," he said. "I'd like to see the
discussion shift from the problem posed by students with mental illness to
what they can bring to campus and what they can teach others. They can teach
themselves and us how to learn from and recover from adversity."▪