Law Students Learn Why It's Crucial to Understand Mental Illness

When Kayla Pope, M.D., J.D., entered law school, she found herself in a pressure cooker. The adversarial environment was fueled by an emphasis on class ranking and a relative lack of academic guidance for students learning the material.

“In the beginning I think a lot of people struggle, but the culture really discourages you from seeking help,” she told Psychiatric News.

Shortly after gaining her law degree, she learned that a fellow student had committed suicide. His death made an impact on Pope and her classmates and left her wondering what, if anything, could have been done to prevent the tragedy.

This question was in part what led Pope to a career in psychiatry and, last year, to spearhead the Law School Mental Health Initiative, aimed at addressing the mental health needs of law students.

As an attorney, Pope represented children and adolescents in child abuse and neglect proceedings, custody disputes, and juvenile criminal proceedings in Virginia.

Her work with children and adolescents, many of whom had endured emotional trauma, sparked her interest in the mechanisms that trigger juvenile delinquency and a desire to teach the courts about the impact of child abuse and neglect on emotional development.

“As an attorney, I saw abused and neglected children coming into court, yet it was hard to prove [the abuse and neglect],” she told Psychiatric News. “I wanted to find ways to capture what they'd experienced and present it as evidence to the court.”

Pope pursued a master's degree in experimental neuropsychology at George Mason University and also began working at the National Institute of Mental Health's Section on Affective Development and Neuroscience under Daniel Pine, M.D., where she had the opportunity to participate in studies involving the psychopathology and neural substrates underlying emotional development.

“The goal of this research was to learn more about how to intervene at a young age in children with emotional problems,” said Pope.“ Early intervention holds a great deal of promise for the patient as well as for society.”

Subsequent work at the American Academy of Child and Adolescent Psychiatry as director of research and training from 1999 to 2001 further ignited her interest in child psychiatry, she said.

She entered medical school at George Washington University in 2001 with the goal of becoming a child psychiatrist and noted that her medical education was vastly different from her law school education because in medical school she received a great deal of guidance and mentorship. “It was more of a supportive environment” than was law school, she recalled.

Pope entered the psychiatry residency program at the University of Maryland/Sheppard Pratt in 2005 and was accepted into the Children's National Medical Center/NIMH Child and Adolescent Psychiatry Research Fellowship in July 2008. She is primarily interested in studying early markers for disruptive behavior in children, she said.

While in residency training, Pope learned about the efforts of Daniel Suvor, a third-year law student at George Washington University, who with the American Bar Association (ABA) Law Student Division, helped to establish March 27 as National Mental Health Day for law students.

In a press release from the ABA, Suvor noted that “the stigma of mental illness and the laws in many states that grant conditional bar admittance to those who battle these conditions have historically prevented many from seeking treatment.”

To educate law students and bar association administrators about the signs and symptoms of depression and anxiety and facts about common mental illnesses, staff with the ABA Law Student Division developed the Toolkit for Student Bar Associations and Administrators, which included educational materials on depression and other mental health problems.

According to data gathered by the ABA, the prevalence of depression among law students and lawyers is higher than that of the general population. As an example, a study conducted by William Eaton, Ph.D, and colleagues using data from the Epidemiological Catchment Area study found that lawyers are 3.6 times as likely as those in the general population to meet criteria for major depressive disorder. The findings were published in the November 1990 Journal of Occupational Medicine.

Last year, Pope reached out to a variety of experts to initiate the formation of a work group under APA's Corresponding Committee on Mental Health on College and University Campuses. The goal is to launch an initiative to educate law students and law school administrators about the signs and symptoms of depression and other common mental disorders and how the disorders are treated.

At the meeting was APA member Saundra Maass-Robinson, M.D., who agreed that there is a need to reach out to law students. Maass-Robinson has worked for more than a decade in Georgia with the Supreme Court Board for Bar Fitness. As a member of the board, she told Psychiatric News that she helped the legal community in Georgia gain a deeper appreciation for encouraging full disclosure by bar applicants as to their past psychiatric and/or substance use history.

“As a result,” she said, “law schools and law students here in Georgia are advised by the board, early in their law school education, to get help if needed for any type of mental illness and that this will not in any way jeopardize their 'fitness' for the bar.”

Maass-Robinson added that in her capacity on the board, she has promoted treatment seeking as advantageous to bar applicants. “Help seeking shows an awareness of the problem as well as maturity in seeking treatment,” she noted.

Additional members of the work group are Melissa Nelken, J.D., a law professor at the University of California Hastings College, and Hanna Stotland, J.D., a Chicago attorney.

The work-group members hope to address some of the barriers that keep law students from accessing mental health treatment. The barriers are significant: for instance, many health insurance plans that cover law students allow only two mental health–related visits. “There is also a great deal of stigma attached to receiving mental health treatment,” she said, due to the competitive nature of law school.

Further, in many states, having a mental illness can prevent students from being admitted to their state bar associations. Under the ABA's model rule on conditional admission to practice law, bar applicants with a diagnosed psychiatric disorder that could interfere with their ability to practice law are placed on a two-year probation in which they are monitored and required to receive psychiatric treatment. If the applicants make it through that probationary period with no undue effects on their legal practice, they gain full admission to the bar.

Work-group members see this rule as potentially problematic in practice. For example, it is unclear whether bar applicants need to disclose to their clients that they are on probationary status while practicing, Maass-Robinson observed.

The work group plans to work with states to iron out these practical issues and to study the effects of the rule on bar applicants with diagnosed mental disorders.

There is a great deal of variability in how state bar associations that have not adopted the model rule deal with applicants with mental disorders, Pope said, and she would like to have work-group members collaborate with states on how applicants in those states fare as well.

Work-group members are also working on creating a position statement for consideration by APA's Board of Trustees as well as the ABA encouraging early diagnosis and treatment by psychiatrists and encouraging law schools to aid in providing access to quality mental health care.

Members of the work group have also been developing programs that foster collaboration between psychiatry departments and law schools. Nelken has been working with the UCSF Forensic Psychiatry Program to develop a pilot educational program for law students at UC Hastings. Similar efforts are under way to develop a relationship between psychiatry programs and law schools in the Washington, D.C., area. The work group also plans to work with leaders of the Association of American Law Schools to educate law school administrators and professors about the impact of mental illness on law students.

Pope said that she is encouraging participation of interested professionals in the work group's activities to improve the mental health of law students. Those who are interested in learning more about the initiative can contact Pope by e-mail at [email protected].▪