Suggestions on Mental Health

Advocacy group offers best practices for campuses dealing with troubled students.
May 17, 2007

One of the major questions to emerge from last month's Virginia Tech shootings is whether colleges are prepared to handle a situation in which a student with mental illness is identified as posing a potential threat to campus.

An advocacy group for people with mental disabilities says there is no consensus among college leaders on how to respond. Many campuses have free counseling services, but when a student's behavior raises red flags, colleges often worry about legal liability, lack a comprehensive plan or have one that is overly punitive, according to officials at the Bazelon Center for Mental Health Law.

In "Supporting Students: A Model Policy for Colleges and Universities," a new report, the center outlines what it describes as best practices for colleges when dealing with the above scenario and others. The policy, which Bazelon officials hope colleges use as a model, calls on institutions to stay away from rigid rules that could discourage students from seeking treatment but that still allow campus officials to intervene when necessary.

"One of our goals here is to send a clear message to students that they can seek help early on and not be penalized," said Robert Bernstein, the center's executive director.

Late last month, center officials said they were troubled by the response to Virginia Tech, which Bernstein called a "hunger for quick fixes and quick legislation" instead of a closer look at what could have been done to treat the gunman long before he attacked. (The center began work on its policy before the Virginia Tech tragedy, although Bernstein said that event makes the recommendations "timely.")

In dealing with cases of troubled students, the report says that colleges should make clear all counseling options and allow them to voluntarily decide whether to seek help. Colleges should suggest that students visit a counseling center when it learns that the student shows academic or behavioral difficulties that "appear to be due to depression or another mental health condition," or when the student has known to have contemplated suicide.

If a referred student doesn't proactively seek the help, the center officials should then reach out. As state law permits, colleges may seek involuntary treatment of the student in "exceptional circumstances," which the report doesn't define in order to "encompass a range of behaviors," said Karen Bower, senior staff attorney at Bazelon. As a last resort, a college can consider using an outside crisis outreach team to contact the student.

Bower said the policy addresses the two areas that are often the stickiest for colleges: confidentiality and student leaves of absences. The report says that in almost all cases, the counseling center should not share information about a student with faculty, staff, administrators or others unless the student consents. When appropriate, the counseling center can encourage the student to consent to sharing the information.

Depending on state law, a center should only disclose information about a student "to the extent needed to protect the student or others from a serious and imminent threat to safety," the report says, adding that "disclosures are permitted only if the student will not consent to interventions that will ameliorate the risk."

Colleges should "reasonably" accommodate students who are mentally ill by allowing them to remain enrolled, or make concessions such as allowing them to take a reduced course load and work from home, according to the report.

Bower said it's also important that colleges don't take disciplinary action against students who choose to take time off or who display "self-injurious" behavior. A counselor's role is to help the student decide whether to take a leave, and in some cases to help the student secure time off. The report says the student should be able to attend campus events while on leave, unless there are documented safety concerns.

Only in "uncommon circumstances" in which students cannot remain safely on campus or meet academic standards should a college require a student to take a leave -- and the decision should be made by a committee that includes the counseling center director, the report says. (It adds that the committee can look into the student's mental condition and seek records, but the search should be limited to essential documents and not rely on access to all confidential records.)

Robb Jones, senior vice president and general counsel for claims management and risk research at United Educators, an insurance company for colleges, said that while he supports the idea of a policy that promotes the individual rights of mentally ill students, colleges should go beyond Bazelon's guidelines by considering the rights of all students and faculty members, and by including safeguards for counselors who find it necessary to share student records.

It would be easier to agree with the report if its rules applied only to cases of depression, Jones said. "But since colleges are often dealing with more serious forms of mental health problems, and determining a student's prognosis can be difficult, there's a problem with coming up with guidelines that will apply to virtually all cases," he added.

Jones said a complete report would go further to note that in some cases, students are better off seeking treatment away from campus, and that the campus would be better off without the student's presence. The company agrees with Bazelon that the best practice is to begin with a voluntary leave policy, and that involuntary removal should be the last resort.

Bernstein said the center is working on another guide that covers what students should know about their rights in mental health cases.

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