Counseling Crisis

Don’t be afraid to get help. That’s the message colleges bombard students with -- telling them that there is no shame in seeking psychological help from campus counseling centers, where professionals can help them deal with a range of problems. But a number of students say that there is in fact good reason to be afraid -- afraid that the very counseling they are encouraged to have could get them expelled.

Several students nationwide who have been suspended as a result of seeking treatment, oftentimes for severe depression, are fighting back -- both in court and through the Department of Education’s Office for Civil Rights -- on the grounds that federal and state disability laws protect their right to stay on campus. Policy and health experts say that universities may be creating legal risks for themselves by barring some students with mental illness, rather than helping them deal with their conditions.

Jordan Nott, a 21-year-old former student at George Washington University, has become a poster child for this movement. He sued the institution and several individuals at the university in District of Columbia court, alleging they “disciplined him, threatened him with criminal prosecution and ultimately ended his college career at the school of his choice” after he sought help for depression at the university’s counseling center.

Nott’s lawyers argue that federal laws, including the Americans With Disabilities Act and Section 504 of the Rehabilitation Act as well as other federal and local laws, should have prevented the university from taking action against him. In court documents, lawyers for GW have denied Nott’s allegations and have asked that his case be dismissed.

Such battles are coming at a time when more students than ever before are arriving on campus with diagnosed mental health issues. According to the 2004 National Survey of Counseling Center Directors, 85.8 percent of counseling directors believe that in recent years there has been an increase in the number of clients with severe psychological problems, and 90 percent believe that students with significant psychological disorders are a growing concern on campuses.

Some institutions, including GW, have considered controversial counseling waivers, which would allow the information of students who seek services at university counseling centers to be shared with administrators. Lawmakers in Colorado are currently considering legislation that could force students seeking help at campus counseling centers to grant Colorado colleges and universities permission to notify a parent, friend, professor or anyone else they desire -- if counselors believe the student is considering suicide or may be a danger to himself or herself.

Stephen Behnke, director of ethics at the American Psychological Association, says that such protocols are “immensely troubling” because they would remove a patient’s confidentiality. “There are already exceptions to confidentiality in order to address emergent situations, such as a risk of harm to self or others,” he says. While such exceptions vary from state to state, the general pattern is that a counselor may take action to force someone to be hospitalized to avoid doing harm -- to the patient or others -- but these waivers don’t generally give broad rights to disclose a patient’s condition, and many psychologists believe that such a system could discourage students from getting help.

Officials with the American Council on Education said in a recent legal brief that they are worried that court and political actions could discourage colleges from helping students facing psychological problems. In February, the council joined with seven other higher education associations in submitting an amicus brief in support of the Massachusetts Institute of Technology's petition to appeal a trial court's denial of summary judgment for two non-clinician administrators in a case focusing on the extent to which student life staff can be held responsible for preventing a student's suicide.

In 2002, the parents of Elizabeth Shin filed a $27.65 million wrongful death lawsuit suit against MIT, charging that its counseling service failed to take their daughter’s depressed situation seriously. Two years earlier, Shin, then a student at MIT, lit herself on fire in her dorm room and died as a result of burns. Ultimately, MIT was cleared of wrongdoing, but some counts filed against individual MIT administrators are still going forward.

“If administrators are required to prevent suicide when they become aware of a student's problems, some reluctantly will avoid involvement with at-risk students,” according to a statement from ACE. “And some will feel they have no choice but to take the most extreme approaches to at-risk students -- trying to have them hospitalized or forcing them to withdraw from the university or notifying their parents -- even when the mental-health experts determine these steps are not in the students' best interest.”

Nott believes that GW’s response in his own case -- and the university’s consideration of the waiver plan -- indicates that administrators are overly concerned about protecting themselves, rather than caring for the overall well-being of students. “When you are looking out for your own liability, you’re not really looking out for the interests of the student, you’re looking out for yourself,” he says. “I suppose every person has to look out for themselves, but this goes way beyond a certain line.”

In fall of 2004, Nott asked his roommate to accompany him to GW’s hospital for psychiatric help. He was feeling depressed and thinking about a close friend, also a student at GW, who had committed suicide in the spring of that year. The student had jumped out the window of his dorm room while Nott and two other friends stood in the hallway, trying to open his locked door.

Nott was prescribed Zoloft, an antidepressant, that fall, and was using it as prescribed. On the night that he went in for psychiatric help, he says that he was disturbed by his depressive thoughts, having read articles about correlations between suicide and antidepressant use. He says that he was not suicidal at any time.

According to one of his lawyers, Karen Bower, of the Bazelon Center for Mental Health, caregivers at GW Hospital promptly informed university officials of Nott’s request for psychiatric help. Within 12 hours of his hospital admission, she says, Nott was given a disciplinary letter barring him from his dorm. And within about 36 hours, George Washington leveled disciplinary charges against Nott and told him he had to withdraw from the university or face suspension, expulsion and/or criminal charges.

The university charged Nott with violating its Code of Conduct by engaging in “endangering behavior,” which is defined as “behavior of any kind that imperils or jeopardizes the health or safety of any person or persons,” including “actions that are endangering to” oneself or others. He was put on interim suspension by the university, evicted from his dorm room, prohibited from attending classes, and barred from GWU property and events. Nott says he was warned that if he came onto campus for any reason, he would be considered a trespasser and could be arrested. Nott, who lives in the Washington area, still cannot visit friends or attend public events on the GW campus.

“The problem is -- after I checked myself into the hospital -- the school never contacted me, except to say that I was basically suspended,” recalls Nott. “The university counseling center should not be involved in that way. They shouldn’t be punishing you, instead of addressing the issues that you’re concerned about.” He’s now a senior at the University of Maryland.

Nott says he expects to graduate this summer, “depending on how hard I work my butt off.” ”I’m focused on finishing as soon as possible," he says, noting that he’s working a part-time job as well. “It’s a challenge, but I’m managing it, and I’ll get through it.”

“Depression -- a lot of it is genetic, and a lot of it is circumstantial,” says Nott. “There could be circumstances in the future that cause me to get depressed, but I hope not.” He is currently not on any psychologically-related medications.

Nott adds that he would never seek help at a campus counseling center again. “I would go outside to a private doctor, something not affiliated with a university,” he says. “It stinks because I don’t want to discourage people from getting help. You just have to be really careful about where you’re going to go.”    

George Washington officials defend their handling of the case. “By law, we cannot talk about the records of a particular student,” according to Tracy Schario, a spokeswoman for GW. “However, in the overwhelming majority of cases, the university has been able to provide appropriate assistance through existing resources and without the need for separation from the university.”

She says that more than 50 students with suicidal thoughts or behaviors go to GW’s counseling center each year and that “the great majority of these students is guided to appropriate services and support within and outside of the university and remain enrolled as students.”

“A few students rise to the level of risk that requires time away from campus and/or classes for more intensive treatment and family support,” says Schario. “Time away provides relief from the stress of campus and academic life in order for students to recover and learn to manage their symptoms and psychological concerns. We hope and expect that these students will recover, return to campus and function fully as successful students. 

“In the case of Jordan Nott, it was certainly our hope and expectation that after receiving proper treatment and successfully resolving his concerns that he would return as a full-time student and resume life in the residence halls,” she adds. “Although he is no longer at GW, we are happy that he is pursuing completion of his academic degree. We wish him well."

Nott’s situation is not unique. In fall 2004, Sue Schaller, now 20, says that she was forced to take a “mandated leave” from New York University, even though she felt like she was recovering from her depressed and suicidal feelings. After communicating via e-mail with a staff member at the university’s counseling center, saying that she was thinking about suicide, she was convinced to sign in for admission to NYU’s Tisch Hospital, and was treated for four nights for depression. The doctor who treated her there advocated that she be allowed to return to NYU, according to Schaller.

“The administrators seemed only concerned that I would try to kill myself,” she says. “The doctor was the only one who seemed to care about me.” Ultimately, Schaller returned home to Virginia to live with her family and sought private counseling.  

“I’ve had to deal with so much, based on that experience,” says Schaller, who, last semester, was allowed to re-enter the university -- without receiving credit for her previous coursework. She lost a total of one semester of coursework. Upon returning, she was required to see a health professional at the university’s counseling center regularly throughout her first semester back. “Obviously, they want to keep me on their radar,” she says.

“If I ‘screw up’ again, I’ll get the boot," says Schaller. “But, I shouldn’t have to feel like I screwed up just because I tried to get help.” Schaller chose not to file suit against NYU, although she believes she would have a legitimate case under anti-bias laws. “It would be like David taking on Goliath,” she says.

NYU officials say that mandated leave is used only as a last resort. Less than 0.3 percent of the approximately 3,400 students who visit the university’s counseling center are required to leave. NYU says that it cannot comment on Schaller’s specific case, due to privacy laws.

“These policies send a message to students that they’ve somehow failed,” says Bower, one of Nott's lawyers. “And others may be discouraged from seeking help for serious conditions.”

Several students have filed complaints with the Department of Education’s Office for Civil Rights, saying that they’ve faced similar situations as Nott and Schaller. In four recent cases, the OCR has sided with such students. OCR is responsible for enforcing Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination based on disability by recipients of federal financial assistance from the U.S. Department of Education.

Last year, the office sent a letter to Lee Snyder, president of Bluffton University, in Ohio, stating that the university’s forced removal of a student who attempted suicide did not comply with federal law. In spring 2004, a female freshman at the university cut herself and took an overdose of pills in an apparent suicide attempt, according to OCR documents. The student was hospitalized for about one week and was diagnosed for the first time with bipolar disorder. “During her hospitalization she worked with mental health professionals who agreed that it would be beneficial to the student to return to her studies upon her discharge,” according to OCR documents.

However, three days after the student's suicide attempt, a university official spoke with the student's mother and told her that the student was being immediately withdrawn from the university.

In 2004, after the student and her mother filed a complaint with OCR, the office found that “the actions taken by the university regarding the student were discriminatory.” OCR found that the university removed the student following her suicide attempt because of its perception that she was mentally ill and incapable of functioning as a student and that it made the decision without providing the student notice of a hearing or an opportunity to be heard. OCR also noted that the university “did not consult with medical personnel, examine objective evidence, ascertain the nature, duration and severity of the risk to the student or other students, or consider mitigating the risk of injury to the student or other students.”

Bluffton ultimately agreed that it had violated the law and has worked with OCR to rectify the situation for the student by reimbursing her for room, board and book fees she paid while at the university. It also made several policy changes, requested by OCR, so that future students are not removed in the same way. OCR documents did not indicate whether the student has re-enrolled at Bluffton or at another college.

According to legal experts, two court cases, Schieszler v. Ferrum College and Shin v. MIT, have weighed heavily -- perhaps too heavily -- on the minds of many administrators in their decisions to remove students. In the former case, a federal court in Virginia found that a private college had a legal “duty of care” to a known suicidal student in a residential setting. The case centered on Michael Frentzel, a freshman at the Ferrum College in 2000. In February of that year, he had an argument with his girlfriend. Soon after, he sent a note to his girlfriend, in which he indicated that he intended to hang himself with his belt. College officials, including a resident assistant, became aware of the note after the girlfriend showed it to them. A few days after the note was written, Frentzel hanged himself in his dorm room.

Frentzel’s aunt and guardian, LaVerne Schieszler, argued in court that college officials “knew or personally should have known that Frentzel was likely to attempt to hurt himself if not properly supervised,” and that they were “negligent by failing to take adequate precautions to insure that Frentzel did not hurt himself.”

The court ultimately found that a “special relationship” existed between Frentzel and certain college officials.

In the Shin case, too, a Massachusetts Superior Court concluded in 2005 that a “special relationship” existed between university staff members and Shin, since the staff members had specific knowledge that the student was at high risk of suicide and that it was “reasonably foreseeable” she “would hurt herself without proper supervision.”  The case is currently being appealed by MIT.

“These rulings have alarmed college administrators nationwide,” says Gary Pavela, director of judicial programs at the University of Maryland at College Park and author of a new book called Questions and Answers on College Student Suicide. “Many fear they will be held liable for failing to determine when troubled or depressed students pose a heightened risk of suicide.”

Pavela says that many administrators have also failed to consider that other court rulings have indicated universities do not have “duty of care” responsibilities. In December 2005, for instance, a Pennsylvania trial court held that two Allegheny College deans had no “duty of care” to prevent the suicide of Charles Mahoney -- a junior who had been treated for severe depression, but wasn’t known to the deans to be an immediate risk of suicide. Previously, in 2000, the Iowa Supreme Court affirmed the status of students as full adults, with primary responsibility for their own conduct. That would mean that administrators could not be held liable in situations where students commit suicide.

Pavela predicts that in the coming months many more students will choose to either pursue the Office for Civil Rights route or sue their universities.