Paul Appelbaum, M.D., tells attendees that universities concerned about
legal liability regarding students with psychiatric diagnoses would do better
to approach each case individually and balance the interests of the student
and the institution.
Credit: David Hathcox
University administrators must move beyond harsh and erratic responses to
students with psychological problems, said a panel of experts at APA's 2008
annual meeting in Washington, D.C., last month.
Colleges and universities may be more anxious today about the mental status
of their students because of the murderous incidents at Virginia Tech and
Northern Illinois University, but that's not the only reason.
"More and more of the 18 million students on college campuses today
have a prior psychiatric history," said Jerald Kay, M.D., a professor of
psychiatry at Wright State University School of Medicine in Dayton, Ohio, and
chair of APA's Corresponding Committee on Mental Health on College and
University Campuses. "About 45 percent of students in one survey
self-reported depression, and 10 percent acknowledged suicidal
Perhaps 25 percent take some kind of psychiatric medication, 23 percent
meet criteria for alcohol or drug dependence, and 44 percent admit to binge
drinking, he said.
Problems often start before college with a high-stress, high-stakes
admissions process on top of any diagnosed psychiatric problems, added Victor
Schwartz, M.D., university dean of students at Yeshiva University in New
"College students are legally adults and entitled to presumptions of
privacy and autonomy," said Schwartz. At the same time, compared with
previous generations, many have been more sheltered growing up, with greater
parental involvement in their education. Students want freedom and structure
at the same time.
When problems do arise on campus, the university's desire to hustle a
student out of the dorm and back home may be rationalized as good for the
greater community, but only rarely makes sense, said Paul Appelbaum, M.D., the
Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and director
of the Division of Psychiatry, Law, and Ethics at Columbia University.
Students given a mandatory leave of absence may be out of sight and out of
mind from the administration's point of view, but they are also away from the
supports provided by other students and counselors, said Appelbaum, who is
also a former APA president and past chair of APA's Council on Psychiatry and
Law. If talking about their problems means being suspended, students will only
hide them more deeply and choose not to seek help. And their friends won't
talk for fear that the student will be punished.
These students also miss the chance to perform academically despite their
psychological problems, he said. Going home might not be a good solution
either, especially if that's the source of some of their problems.
"Home is not always a sanctuary," said Appelbaum. "not
that it's never appropriate to send a student home, but that should be an
individualized determination, not a reflexive policy."
The interchange of information—or the lack of it—between
student, parents, and university is another complex and murky point, said the
speakers. Several federal laws govern control and release of health and
educational records, but frequent misunderstanding of these laws often
provokes exaggerated fears among administrators, said Appelbaum. College
officials have hesitated to disclose information about a troubled student,
even to parents. Some colleges now encourage students to sign forms
voluntarily when they first enroll to permit disclosure to parents.
"There are good reasons to limit non-consensual disclosure, but
liability concerns should not overwhelm good judgment," said Appelbaum."
Any exception requires an articulable and significant threat to self or
Greater communication among all parties might be a good start, said
"Talk before the crisis happens, and learn from each other," he
said. "Know the law well to avoid unnecessary anxieties. Remember that
every situation is unique, no one can predict the future, and we must be
prepared that bad things can still happen."
The most protective defense for universities against liability is to act
like good therapists and put students first, said Appelbaum.
"Avoid blanket policies, do an individual medical and mental health
evaluation, and assess risk," he said. "While some students won't
be able to continue their enrollment, they should have access to due process
and a right to appeal." ▪