Treating College Students Means Doing Your Homework

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 said.

Need for College Student Care Acute

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, Privacy Points

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,” Vanderpool advised.

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 or others.

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 Campus.

“The bottom line” for psychiatrists treating college students, Vanderpool said, “is to deliver good clinical care and to document the treatment process.”

More information about risk management for psychiatrists is posted at<www.prms.com>.▪