Colleges face dilemma deciding fate of mentally ill students

[Mandy]

I found this interesting, especially the legal issues, and problems with identification of people under high stress, and discussion of "independence" and social support systems.

Colleges face dilemma deciding fate of mentally ill students

Web Posted: 04/20/2007 12:30 AM CDT

Melissa Ludwig
Express-News

Campus administrators, health professionals and police, caught between federal privacy and anti-discrimination laws and the need to protect their campuses, face a daunting challenge deciding the fate of mentally ill students.

Before 23-year-old Virginia Tech student Cho Seung-Hui gunned down 32 students and teachers Monday, his violent, lurid work in a creative writing class sparked a string of efforts to get him help.

In 2005, after complaints from two female students that Cho was harassing them and a tip that he might be suicidal, campus police tried to have him involuntarily committed to a mental institution. The evaluating doctor found that Cho was mentally ill, but not an imminent danger. The judge declined to commit him, ordering outpatient treatment instead.

In hindsight, the missed opportunity is haunting. In the moment, campus officials say, deciding if odd behavior adds up to mental illness, or presents a danger of suicide or violence against others, involves a web of factors.

"You have to look at all these angles, your legal obligation, your human obligation, your obligation to the individual and campus community," said Gage Paine, vice president for student affairs at the University of Texas at San Antonio. "The problem in situations like this is that we need to be right 100 percent of the time, but that's not real. All the systems in the world don't always help mentally ill people."

Since 2002, campus officials have been riding a seesaw when it comes to mental health issues.

That year, the parents of Elizabeth Shin, a student at the Massachusetts Institute of Technology, sued the school for $27 million after Shin committed suicide by setting herself on fire in her dorm room. They faulted the university's counseling services for not dealing with her depression adequately. The university settled for an undisclosed sum.

n the wake of that case, universities moved hard in one direction, kicking students they suspected of being unstable off campus, either permanently or temporarily. That move sparked its own backlash.

Last year, George Washington University settled with Jordan Nott, a student who sued the university after he was kicked off campus when he sought treatment for depression. The terms of the settlement are confidential.

Last month, Virginia passed the nation's first law banning public colleges and universities from punishing or kicking out students solely because they tried to commit suicide or seek mental health treatment.

Some campuses, notably the University of Illinois and the University of Washington, require students who talk about suicide to get counseling or take a leave, according to March article on Salon.com about the challenges campus officials face dealing with students they believe are suicidal.

But even if students do get counseling, federal privacy laws bar the counselor from sharing information with other university professionals unless the student makes a specific threat, said Elizabeth Stanczak, director of counseling and health services at UTSA.

And the Americans with Disabilities Act, which protects mentally ill people from discrimination, prevents campus officials from tossing someone out of school simply for being depressed or schizophrenic. If a student is clearly violating the campus' code of conduct, however, suspension is an option, Paine said.

Part of the challenge of identifying and dealing with mental illness has to do with the very nature of campus life. Many universities tolerate a higher level of wacky behavior than other institutions, and being weird, even dreaming up violent scenes for a writing class, doesn't mean a student is going to kill people, Stanczak said.

"We cannot take away someone's rights based on assumption," she said.

Paine describes an incident 15 years ago, when she worked at the University of Texas at Austin, that she said demonstrates the tightrope administrators walk.

At that time, a student had a psychotic breakdown in class and took a voluntary mental health leave. He was allowed to come back after doctors prescribed medication. But doctors got the diagnosis wrong, and when the student returned to class, he had a second breakdown. The school tried to suspend the student, but his lawyer warned them that such a move would violate the Americans with Disabilities Act. The university allowed the student to stay, but he was later kicked out after threatening someone with a knife.

"People in that class thought we were wrong to let him back in," Paine said. "There was no good decision in that situation. Should we have violated ADA? No."

Stanczak, who attended a conference in Fort Worth this week of the Texas University and College Counseling Directors Association, said she and her colleagues expect changes as a result of the Virginia Tech killings.

"You will see knee jerk responses on campuses — faculty seeing things in students they didn't pay attention to before," she said. "We are all saying, 'Let's take that one step a little further and be cautious.'"

Psychologist Robert Geffner said paying attention to warning signs and doing something about them is crucial.

"What is clear is the prevention efforts, the follow-through, the ways of identifying people who may be under high stress and may be in trouble are not as good as we would like," he said. "We need to put more effort into these situations, not only at the college level but at all educational levels."

Rethinking how we live together, as a society, is part of the challenge, said Soad Michelsen, a psychiatrist at Southwest Mental Health Center, a pediatric hospital, and president-elect of the Bexar County Psychiatric Society.

American culture values independence and, as a result, people don't always watch out for each other. With Cho's long history of mental instability, there should have been a support system for him and mentors to follow up on his progress, she said.

"When you look at these school shootings, what kind of cultures really have this problem?" Michelsen said. "It only happens in the more independent cultures. Have more empathy toward the person sitting right by you."

From HERE