Mental Health Milieu

Health professionals ponder the complexities of serving mentally ill students, while protecting their privacy and preventing stigmatization.
June 2, 2006

She thought she was a cat.

She tackled a guy on the street whom she wanted to be her boyfriend.

She tried to commit suicide.

This all happened just after Lizzie Simon had graduated high school and was accepted at Columbia University. In the months before she started college, she was wrongly diagnosed with depression. When she was prescribed drugs that worsened her condition, doctors ultimately determined that she had bipolar disorder. When she needed further help once in college, she tried to go to a counselor at the campus health center. But the counselor, she says, spent an inordinate amount of time focusing in on why she had wanted to be a cat.

“This wasn’t some Freudian issue I was dealing with,” Simon told a group of keenly interested health professionals during a Thursday session at the annual meeting of the American College Health Association. “I was sick and needed help.” She ultimately stopped going to therapy and relied on private doctors to help get her through her ups and downs.

“It was a scary thing being in college with this on my back,” said Simon. “I had all kinds of self-esteem and identity issues.... All of these complex emotions I had were never addressed by the doctors.” Nor by campus health professionals, although she admits she was wary of opening up to them for fear of them sharing her information with people that she didn’t want to know about her illness, namely administrators. 

Now 30, Simon has been on lithium for 13 years and has become an advocate for high school and college students coping with mental health issues. She’s written a book called Detour: My Bipolar Road Trip in 4-D, and has worked with MTV to produce programs that help young people dealing with similar emotions understand that they are not alone.

Many health professionals think they’re doing things right, said Simon. But from a student’s perspective, that may not be the case.

Throughout the conference, several health professionals said that this kind of quandary has been crossing their paths with more frequency. And many were looking for answers on how to help students feel less stigmatized, while concurrently battling administrators at some institutions who are taking steps that some feel do not have students’ well-being in mind.

In a session called “Mental Health 2006 Update,” Richard Kadison, the chief of mental health services at Harvard University, detailed the complex issues facing professionals who are coping with cases like Simon’s on a regular basis. He noted that more students are seeking treatment for mental illness while in college than ever before. Plus, more students are being treated for conditions like Attention Deficit Hyperactivity Disorder before they enter college, so more are in need of help maintaining their medications once there.

Soon after Kadison began his presentation, he offered a slide showing a boat paddle store, with a sign above it that read “Shit Creek.” “This is where a lot of us feel we are right now,” he said.

The hardest challenge, according to Kadison, is to get administrators and students to help in the effort to reduce stigma surrounding mental illness. He said that gathering institution-specific data on the numbers of students who need assistance is one route that can help get more attention focused on this topic. He also said that there has been no real legal precedent that would make administrators liable in cases where students hurt themselves on campus.

But what if a student is in such dire straits that he or she needs to leave college?

“You need to have some involuntary medical leave policy spelled out in your student handbook,” suggested Kadison. “If a student’s behavior is disruptive, the dean would have the right to tell them that they have the right to take involuntary leave.”

But Kadison noted that handbook policies aren’t effective in the short-term when a student is dealing with his or her problem but is not disruptive. He said that Harvard is fortunate in that it has a dedicated infirmary for students who are sick but remain in college. “The most difficult question we’re left with is when should a student leave,” he said.

“One of the things I hope you’ll take away is having students involved is crucial in helping administrators understand these issues,” said Kadison. He said that student support and mental health awareness groups help reduce stigmatization and provide avenues for talking about problems in a possibly less stressful environment.

Simon said that she understands all too well the difficulties involved with trying to serve mentally ill students. In an effort to help, she came armed with some recommendations from the Bazelon Center for Mental Health Law to share with health professionals regarding rights for students with mental illness. Lawyers with the organization are currently representing Jordan Nott, a former student at George Washington University, who is suing the institution because he claims he was forced to leave the institution and threatened with criminal prosecution after he sought help for depression at the university’s counseling center. The litigation was brought up several times throughout the conference.

The recommendations included nurturing the mental health of all students and working with administrators to create policies that are not punitive toward students. Sounds good, but even Simon said that she questions how far institutions should go in accommodating students who clearly need more assistance than a college or university health professional can offer. “Not every case is the same,” she said. “It’s hard.”


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